Advertisement

International Urology and Nephrology

, Volume 50, Issue 12, pp 2239–2244 | Cite as

Both insulin resistance and metabolic syndrome accelerate the progression of chronic kidney disease among Chinese adults: results from a 3-year follow-up study

  • Aixia Ma
  • Fuqiang Liu
  • Chuan Wang
  • Kai Liang
  • Fei Yan
  • Xinguo Hou
  • Jinbo LiuEmail author
  • Li ChenEmail author
Nephrology - Original Paper
  • 75 Downloads

Abstract

Background

Metabolic syndrome (MetS) has been found to be associated with an increased risk for chronic kidney disease (CKD). However, the relationship between insulin resistance (IR), which is believed to play a central role in the pathogenesis of MetS, and CKD is still unclear in Chinese adults and needs further investigation.

Methods

This 3-year follow-up study included 3237 middle-aged and elderly Chinese without CKD at baseline. Estimated glomerular filtration rate (eGFR) 60–90 mL/min/1.73 m2 was defined as the mildly reduced eGFR; CKD was defined as eGFR < 60 mL/min/1.73 m2. MetS was defined based on the China guideline for type 2 diabetes. IR was measured by the homeostatic model assessment of IR (HOMA-IR). Incidences of mildly reduced eGFR and CKD from normal eGFR were calculated. The roles of MetS and IR in predicting the progression of CKD were estimated using multiple logistic regression models.

Results

The incidences of CKD and mildly reduced eGFR for the entire cohort were 20.08 and 33.28 per 1000 person-years, respectively. A large proportion [13.1% (182/1394)] of patients with mildly reduced eGFR progressed to CKD in 3 years. After accounting for age, gender, five components of MetS and HOMA-IR in multiple logistic regression model, only IR presented increased OR (1.119, 95% CI 1.052–1.189, p < 0.001) for CKD. When we included MetS instead of its five components in model, both MetS (OR 1.420, 95% CI 1.020–1.977, p = 0.038) and HOMA-IR (OR 1.118, 95% CI 1.055–1.186, p < 0.001) showed increased risk for CKD progression.

Conclusions

Both IR and MetS accelerate the progression of CKD among Chinese adults. Single metabolic abnormality did not have enough potency to induce the occurrence of CKD in 3 years.

Keywords

Metabolic syndrome Insulin resistance Chronic kidney disease Progression 

Notes

Acknowledgements

This study was supported by the National Natural Science Foundation of China (Nos. 81700739, 81670706) and the National Health and Family Planning Commission Foundation (No. 201502007). We would like to thank LetPub (http://www.letpub.com) for providing linguistic assistance during the preparation of this manuscript.

Compliance with ethical standards

Confiict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Zhang L, Wang F, Wang L, Wang W, Liu B, Liu J, Chen M, He Q, Liao Y, Yu X, Chen N, Zhang JE, Hu Z, Liu F, Hong D, Ma L, Liu H, Zhou X, Chen J, Pan L, Chen W, Li X, Wang H (2012) Prevalence of chronic kidney disease in China: a cross-sectional survey. Lancet 379(9818):815–822CrossRefGoogle Scholar
  2. 2.
    White SL, Cass A, Atkins RC, Chadban SJ (2005) Chronic kidney disease in the general population. Adv Chronic Kidney Dis 12(1):5–13CrossRefGoogle Scholar
  3. 3.
    Chen J, Kong X, Jia X, Li W, Wang Z, Cui M, Xu D (2017) Association between metabolic syndrome and chronic kidney disease in a Chinese urban population. Clin Chim Acta 470:103–108CrossRefGoogle Scholar
  4. 4.
    Luk AO, So WY, Ma RC, Kong AP, Ozaki R, Ng VS, Yu LW, Lau WW, Yang X, Chow FC, Chan JC, Tong PC (2008) Metabolic syndrome predicts new onset of chronic kidney disease in 5,829 patients with type 2 diabetes: a 5-year prospective analysis of the Hong Kong Diabetes Registry. Diabetes Care 31(12):2357–2361CrossRefGoogle Scholar
  5. 5.
    Hayashi K, Takayama M, Abe T, Kanda T, Hirose H, Shimizu-Hirota R, Shiomi E, Iwao Y, Itoh H (2017) Investigation of metabolic factors associated with eGFR decline over 1 year in a Japanese population without CKD. J Atheroscler Thromb 24(8):863–875CrossRefGoogle Scholar
  6. 6.
    Park JH, Oh SW, Ahn SY, Kim S, Na KY, Chae DW, Chin HJ (2013) Decreased estimated glomerular filtration rate is not directly related to increased insulin resistance. Diabetes Res Clin Pract 99(3):366–371CrossRefGoogle Scholar
  7. 7.
    Jang CM, Hyun YY, Lee KB, Kim H (2015) Insulin resistance is associated with the development of albuminuria in Korean subjects without diabetes. Endocrine 48(1):203–210CrossRefGoogle Scholar
  8. 8.
    Chen S, Chen Y, Liu X, Li M, Wu B, Li Y, Liang Y, Shao X, Holthofer H, Zou H (2013) Association of insulin resistance with chronic kidney disease in non-diabetic subjects with normal weight. PLoS ONE 8(9):e74058CrossRefGoogle Scholar
  9. 9.
    Jing C, Xu S, Ming J, Cai J, Zhang R, Shen H, Yang W, Ji Q (2015) Insulin resistance is not independently associated with chronic kidney disease in Chinese population: a population-based cross-sectional study. Clin Chim Acta 448:232–237CrossRefGoogle Scholar
  10. 10.
    Spoto B, Pisano A, Zoccali C (2016) Insulin resistance in chronic kidney disease: a systematic review. Am J Physiol Renal Physiol 311(6):F1087–F1108CrossRefGoogle Scholar
  11. 11.
    Teta D (2015) Insulin resistance as a therapeutic target for chronic kidney disease. J Ren Nutr 25(2):226–229CrossRefGoogle Scholar
  12. 12.
    Ning G (2012) Risk evaluation of cAncers in Chinese diabeTic individuals: a lONgitudinal (REACTION) study. J Diabetes 4(2):172–173CrossRefGoogle Scholar
  13. 13.
    Ning G, Bloomgarden Z (2015) Diabetes and cancer: findings from the REACTION studyREACTION. J Diabetes 7(2):143–144CrossRefGoogle Scholar
  14. 14.
    Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612CrossRefGoogle Scholar
  15. 15.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(2 Suppl 1):S1–S266Google Scholar
  16. 16.
    Society CD (2014) China guideline for type 2 diabetes. Chin J Diabetes Mellit 6(7):447–498Google Scholar
  17. 17.
    Mathew RO, Bangalore S, Lavelle MP, Pellikka PA, Sidhu MS, Boden WE, Asif A (2017) Diagnosis and management of atherosclerotic cardiovascular disease in chronic kidney disease: a review. Kidney Int 91(4):797–807CrossRefGoogle Scholar
  18. 18.
    Roy SK, Cespedes A, Li D, Choi TY, Budoff MJ (2011) Mild and moderate pre-dialysis chronic kidney disease is associated with increased coronary artery calcium. Vasc Health Risk Manag 7:719–724PubMedPubMedCentralGoogle Scholar
  19. 19.
    Natali A, Boldrini B, Baldi S, Rossi M, Landi P, Severi S, Solini A, Ferrannini E (2014) Impact of mild to moderate reductions of glomerular filtration rate on coronary artery disease severity. Nutr Metab Cardiovasc Dis 24(6):681–688CrossRefGoogle Scholar
  20. 20.
    Chen J, Muntner P, Hamm LL, Jones DW, Batuman V, Fonseca V, Whelton PK, He J (2004) The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med 140(3):167–174CrossRefGoogle Scholar
  21. 21.
    Wang C, Liang K, Zhang X, Li C, Yang W, Ma Z, Sun Y, Song J, Lin P, Gong L, Wang M, Liu F, Li W, Xiao J, Yan F, Yang J, Wang L, Tian M, Liu J, Zhao R, Hou X, Chen L (2014) Metabolic abnormalities, but not obesity, contribute to the mildly reduced eGFR in middle-aged and elderly Chinese. Int Urol Nephrol 46(9):1793–1799CrossRefGoogle Scholar
  22. 22.
    Fliser D, Pacini G, Engelleiter R, Kautzky-Willer A, Prager R, Franek E, Ritz E (1998) Insulin resistance and hyperinsulinemia are already present in patients with incipient renal disease. Kidney Int 53(5):1343–1347CrossRefGoogle Scholar
  23. 23.
    DeFronzo RA, Alvestrand A, Smith D, Hendler R, Hendler E, Wahren J (1981) Insulin resistance in uremia. J Clin Invest 67(2):563–568CrossRefGoogle Scholar
  24. 24.
    Liao MT, Sung CC, Hung KC, Wu CC, Lo L, Lu KC (2012) Insulin resistance in patients with chronic kidney disease. J Biomed Biotechnol.  https://doi.org/10.1155/2012/691369 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    de Boer IH, Mehrotra R (2014) Insulin resistance in chronic kidney disease: a step closer to effective evaluation and treatment. Kidney Int 86(2):243–245CrossRefGoogle Scholar
  26. 26.
    Jessani S, Levey AS, Bux R, Inker LA, Islam M, Chaturvedi N, Mariat C, Schmid CH, Jafar TH (2014) Estimation of GFR in South Asians: a study from the general population in Pakistan. Am J Kidney Dis 63(1):49–58CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Aixia Ma
    • 1
    • 2
    • 3
  • Fuqiang Liu
    • 1
    • 2
    • 3
  • Chuan Wang
    • 1
    • 2
    • 3
  • Kai Liang
    • 1
    • 2
    • 3
  • Fei Yan
    • 1
    • 2
    • 3
  • Xinguo Hou
    • 1
    • 2
    • 3
  • Jinbo Liu
    • 1
    • 2
    • 3
    Email author
  • Li Chen
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of EndocrinologyQilu Hospital of Shandong UniversityJinanChina
  2. 2.Institute of Endocrinology and MetabolismShandong UniversityJinanChina
  3. 3.Key Laboratory of Endocrinology and MetabolismShandong Province in Medicine & HealthJinanChina

Personalised recommendations