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The Effect of HMG-CoA Reductase Inhibitor on Insulin Resistance in Patients Undergoing Peritoneal Dialysis

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Abstract

Background

Insulin resistance is associated with the progression of atherosclerosis and is reported to predict cardiovascular mortality in patients with end-stage renal disease (ESRD). Although statins exert pleiotropic effects, it is uncertain whether statin therapy improves insulin resistance in these patients. In this prospective randomized controlled trial, we aimed to evaluate the effects of statin on insulin resistance among 70 patients undergoing peritoneal dialysis (PD).

Methods

Patients were randomized into a statin group (n = 35) or a control group (n = 35). The statin group received 10 mg per day of rosuvastatin for 6 months. We determined insulin resistance by homeostatic model assessment of insulin resistance (HOMA-IR) index. Serum concentrations of adipokines such as adiponectin, leptin, and resistin were measured using enzyme-linked immunosorbent (ELISA) assay. As inflammatory markers, high sensitive C-reactive protein (hsCRP) and interleukin-6 were also measured.

Results

There were no significant differences in baseline characteristics between the two groups. Compared to baseline value, statin treatment significantly decreased HOMA-IR index from 2.37 ± 1.08 to 2.05 ± 0.82 (P = 0.014). There was a concordant decrease in hsCRP levels in the statin group (2.05 ± 1.57 to 1.21 ± 0.84 mg/L, P < 0.001), but such improvements were not observed in the control group. When between-group differences in these parameters were compared, hsCRP levels were more decreased in the statin group than in the control group (P = 0.021 for between-group difference), whereas HOMA-IR index was not (P = 0.189 for between-group difference). During this period, statin treatment did not result in the improved adipokine profiles.

Conclusion

This study showed that statin therapy failed to improve insulin resistance in PD patients despite a significant decline in hsCRP levels after statin treatment. Our finding suggests that reducing inflammation by statin is of limited help to fully attenuate insulin resistance in these patients.

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Abbreviations

BMI:

Body mass index

CKD:

Chronic kidney disease

DBP:

Diastolic blood pressure

ELSIA:

Enzyme-linked immunosorbent assay

ESRD:

End-stage renal disease

HDL:

High density lipoprotein

HOMA-IR:

Homeostasis model assessment insulin resistance

hsCRP:

High sensitive C-reactive protein

IL-6:

Interleukin-6

LDL:

Low density lipoprotein

PD:

Peritoneal dialysis

PTH:

Parathyroid hormone

RAS:

Renin angiotensin system

SBP:

Systolic blood pressure

RRF:

Residual renal function

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Acknowledgment

This work was supported by the Yonsei University (Brain Korea 21) Project for Medical Sciences, a grant from the Korea Science and Engineering Foundation funded by the Korean government (MOST) (R13-2002-054-04001-0), and a grant of the Korea Healthcare Technology R&D Project of the Ministry for Health, Welfare & Family Affairs, Republic of Korea (A084001).

Conflict of interest statement

None declared.

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Authors and Affiliations

  1. Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Korea, 120-752

    Fa Mee Doh, Hyang Mo Koo, Mi Jung Lee, Dong Ho Shin, Chan Ho Kim, Kwang Il Ko, Hyung Jung Oh, Tae-Hyun Yoo, Shin-Wook Kang, Dae-Suk Han & Seung Hyeok Han

  2. Division of Nephrology, NHIC Ilsan Hospital, Goyangshi, Gyeonggi-do, Korea

    Tae-Ik Chang

  3. Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea

    Shin-Wook Kang

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  1. Fa Mee Doh
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Correspondence to Seung Hyeok Han.

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Doh, F.M., Chang, TI., Koo, H.M. et al. The Effect of HMG-CoA Reductase Inhibitor on Insulin Resistance in Patients Undergoing Peritoneal Dialysis. Cardiovasc Drugs Ther 26, 501–509 (2012). https://doi.org/10.1007/s10557-012-6412-2

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