Hyperinsulinemia and Insulin Resistance in Pediatric Patients with Chronic Kidney Disease

Abstract

Background: Pediatric chronic kidney disease (CKD) is associated with disturbance of glucose metabolism & insulin receptor sensitivity leading to impaired glucose tolerance & insulin resistance (IR), which are potential risk factors for cardiovascular disease (CVD). Hyperinsulinemia and IR are not extensively investigated in children with CKD, especially in different stages of CKD. Subjects & methods: A total of 87 children and adolescents with chronic kidney disease (CKD); (29 CKD stage 2-4, pre-dialysis group & 29 CKD stage 5, dialysis group) & 29 age & gender matched controls were enrolled in the current cross-sectional study. Homeostasis model assessment of insulin resistance (HOMA-IR) using fasting insulin & glucose, where IR was considered if HOMA-IR was ≥ 4.39. Aim: Detect hyperinsulinemia & IR in pediatric CKD patients. Results: Fasting insulin & glucose hadn’t significantly changed between CKD patients & controls (p=0.7, 0.3 respectively), while IR represented by HOMA-IR was found in a total of 11 (12.6%) CKD patients (6, 6.89% CKD5d & 5, 5.74% CKD 2-4) with no significant difference between pre-dialysis & dialysis groups (p>0.05), while it was significant with controls (p= 0.039), meanwhile, the total means of HOMA-IR between were no statistically significant between all CKD patients & (p=0.64). HOMA-IR correlated positively to dialysis durations (p= <0.001, <0.001 respectively), but hadn’t changed with BMI. Conclusion: Pre-dialysis & dialysis CKD pediatric patients are at a high risk of IR & hence CVD. CKD & dialysis durations are independent risk factors for IR.