Insulin Resistance in Chronic Kidney Disease
Summary
Insulin resistance represents a pervasive metabolic disturbance in patients with chronic kidney disease, emerging early in the decline of renal function and persisting through end-stage stages. Impairment of insulin receptor signalling in target tissues, notably skeletal muscle and adipose, results from uremic toxin accumulation, chronic inflammation, oxidative stress and dysregulated adipokine profiles. This metabolic defect contributes not only to hyperglycaemia in those with pre-existing diabetes but also to cardiovascular complications, endothelial dysfunction and accelerated atherosclerosis in non-diabetic CKD cohorts. The interplay between insulin resistance and protein-energy wasting further exacerbates muscle catabolism, heightening the risk of sarcopenia and frailty. Therapeutic approaches that address uremia-associated factors, modulate mitochondrial function and restore insulin signalling hold promise for attenuating the systemic burden of CKD and reducing morbidity and mortality on a global scale.
Research from Nature Portfolio
In a large intensive care cohort of patients with type 2 diabetes and chronic kidney disease, elevated blood urea nitrogen to serum albumin ratio emerged as a simple yet powerful predictor of 30-day and 90-day mortality as well as length of stay. Stratification by this ratio identified subgroups at markedly higher risk, suggesting its utility for early risk assessment and potential targeting of nutritional or extracorporeal interventions to improve outcomes.
Insulin Resistance in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in insulin resistance in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic kidney disease (CKD): Progressive decline in renal function, defined by reduced glomerular filtration rate and markers of kidney damage over time.
Insulin resistance (IR): A state in which cells have a diminished ability to respond to insulin stimulation, leading to impaired glucose uptake.
Homeostasis model assessment for insulin resistance (HOMA-IR): A calculated index from fasting insulin and glucose levels used to estimate hepatic and peripheral insulin sensitivity.
Advanced glycation end products (AGEs): Proteins or lipids modified by non-enzymatic glycation, contributing to oxidative stress and vascular injury.
Blood urea nitrogen to serum albumin ratio (BAR): A composite marker reflecting nutritional and metabolic status, used to predict mortality risk in CKD.
Oxidative phosphorylation: The mitochondrial process of ATP generation via electron transport and proton gradient, often impaired in uraemic conditions.
References
- Associations of Glucometabolic Indices with Aortic Stiffness in Patients Undergoing Peritoneal Dialysis with and without Diabetes Mellitus. International Journal of Molecular Sciences (2023).
- Blood urea nitrogen to serum albumin ratio as a new prognostic indicator in type 2 diabetes mellitus patients with chronic kidney disease. Scientific Reports (2024).
- Role and Treatment of Insulin Resistance in Patients with Chronic Kidney Disease: A Review. Nutrients (2021).
- Development and Validation of an Insulin Resistance Model for a Population with Chronic Kidney Disease Using a Machine Learning Approach. Nutrients (2022).
- Mitochondrial Activity and Skeletal Muscle Insulin Resistance in Kidney Disease. International Journal of Molecular Sciences (2019).
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