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Association between relative fat mass, uric acid, and insulin resistance in children with chronic kidney disease

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Abstract

Introduction

This cross-sectional study investigates the association between insulin resistance (IR) and serum uric acid (sUA) and relative fat (RFM) and lean mass (RLM) profiles in children with chronic kidney disease (CKD).

Material and methods

RLM and RFM were assessed by bioimpedance spectroscopy in 41 children and adolescents. Normal weight obesity (NWO) was defined as normal height-age body mass index and RFM >85th percentile, according to age and sex. Homeostatic model assessment of insulin resistance (HOMA-IR) level >95th percentile, according to sex and pubertal stage, and sUA >7 mg/dl were used to define IR and hyperuricemia, respectively.

Results

High RFM (15 patients) and NWO (7 patients) were associated with higher HOMA-IR in total (p < 0.001) and normal-weight patients (p = 0.004), respectively. RFM was positively and RLM negatively correlated to HOMA-IR (rs = 0.500, p = 0.001 and rs = −0.539, p < 0.001, respectively) and sUA (rs = 0.370, p = 0.017 and rs = −0.325, p = 0.038, respectively), while sUA was positively correlated to HOMA-IR (rs = 0.337, p = 0.031). Hyperuricemia (16 patients) was positively associated with higher RFM and HOMA-IR (p = 0.001 and p = 0.010, respectively). The correlation between sUA and HOMA-IR lost significance after adjustment for RFM. In logistic regression analysis, a 5% increase in RFM was associated with IR (11 patients) independently of the age, sex, sUA, and CKD stage in both total (OR 2.174, 95% CI 1.115–4.225) and normal-weight (OR 3.504, 95% CI 1.110–11.123) patients.

Conclusion

Children with high RFM, including those presenting NWO, are at risk for IR regardless of CKD stage. RFM is probably the mediator of the link between sUA and IR.

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Authors and Affiliations

  1. Pediatric Nephrology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece

    Vasiliki Karava, John Dotis, Antonia Kondou, Fotios Papachristou & Nikoleta Printza

  2. Pediatric Endocrinology Unit, 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Athanasios Christoforidis

  3. Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Vassilios Liakopoulos

  4. Biopathology Laboratory, Hippokratio General Hospital, Thessaloniki, Greece

    Konstantina Tsioni

  5. 3rd Department of Pediatrics, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Konstantinos Kollios

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  1. Vasiliki Karava
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  2. John Dotis
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Correspondence to Vasiliki Karava.

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All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Karava, V., Dotis, J., Kondou, A. et al. Association between relative fat mass, uric acid, and insulin resistance in children with chronic kidney disease. Pediatr Nephrol 36, 425–434 (2021). https://doi.org/10.1007/s00467-020-04716-y

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  • DOI: https://doi.org/10.1007/s00467-020-04716-y

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