Pediatric Nephrology

, Volume 22, Issue 10, pp 1751–1756

Hyperinsulinemia in pediatric patients with chronic kidney disease: the role of tumor necrosis factor-α

Original Article

DOI: 10.1007/s00467-007-0533-z

Cite this article as:
Lai, H.L., Kartal, J. & Mitsnefes, M. Pediatr Nephrol (2007) 22: 1751. doi:10.1007/s00467-007-0533-z

Abstract

We sought to determine the prevalence of hyperinsulinemia and insulin resistance in pediatric patients with chronic kidney disease (CKD) stages 2–4. Data were collected on 43 subjects, aged 6–21 years with mean glomerular filtration rate (GFR) = 47 ml/min per 1.73 m2 body surface area. Patients were grouped by body mass index (BMI) as either non-lean (>85th percentile) or lean (≤85th percentile). Fourteen (33%) subjects had hyperinsulinemia, and seven (16%) had elevated homeostasis model assessment of insulin resistance (HOMA-IR). Non-lean subjects had a higher serum insulin level (21.0 μU/ml vs 13.4 μU/ml, P < 0.0001) and HOMA-IR (4.9 vs 3.2, P < 0.001) than lean subjects had. The prevalence of hyperinsulinemia was higher in non-lean patients (40%) than in lean patients (29%) but was not statistically significant. High HOMA-IR was present in six (40%) non-lean subjects and in one lean subject (P < 0.001). Correlation analysis demonstrated that serum insulin level was significantly associated with BMI, leptin and tumor necrosis factor (TNF)-α. Stepwise regression determined that increased BMI (P = 0.003) and TNF-α (P = 0.01) independently predicted higher insulin level in the whole cohort. Separate analysis for lean subjects showed no significant associations between serum insulin level and BMI; TNF-α was the only independent predictor of serum insulin (β = 1.11, P = 0.01). We conclude that hyperinsulinemia and insulin resistance are frequent in pediatric CKD. In lean patients inflammation appears to be an important determinant of serum insulin level.

Keywords

TNF-αChildrenPediatricChronic kidney diseaseHyperinsulinemiaInsulin resistance

Abbreviations

CV

cardiovascular

CKD

chronic kidney disease

GFR

glomerular filtration rate

TNF-α

tumor necrosis factor-α

hsCRP

high-sensitivity C-reactive protein

IL

interleukin

BMI

body mass index

SBP

systolic blood pressure

DBP

diastolic blood pressure

HOMA-IR

homeostasis model assessment of insulin resistance

NFκB

nuclear factor κB

IRS-1

insulin receptor substrate-1

Copyright information

© IPNA 2007

Authors and Affiliations

  1. 1.Division of Nephrology and HypertensionCincinnati Children’s Hospital Medical CenterCincinnatiUSA