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学科主题: 临床医学
题名:
Clinical Correlates of Insulin Sensitivity and Its Association with Mortality among Men with CKD Stages 3 and 4
作者: Xu, Hong1,2,3; Huang, Xiaoyan1,2,4; Arnlov, Johan5,7; Cederholm, Tommy6; Stenvinkel, Peter1,2; Lindholm, Bengt1,2; Riserus, Ulf6; Carrero, Juan Jesus
刊名: CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
发表日期: 2014-04-07
DOI: 10.2215/CJN.05230513
卷: 9, 期:4, 页:690-697
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Urology & Nephrology
研究领域[WOS]: Urology & Nephrology
关键词[WOS]: CHRONIC KIDNEY-DISEASE ; GLOMERULAR-FILTRATION-RATE ; COMMUNITY-BASED COHORT ; METABOLIC SYNDROME ; CARDIOVASCULAR-DISEASE ; PHYSICAL-ACTIVITY ; SKELETAL-MUSCLE ; OLDER-ADULTS ; RISK-FACTORS ; CYSTATIN-C
英文摘要:

Background and objectivesInsulin resistance participates in the pathogenesis of multiple metabolic and cardiovascular diseases. CKD patients have impaired insulin sensitivity, but the clinical correlates and outcome associations of impaired insulin sensitivity in this vulnerable population are not well defined.Design, setting, participants, & measurementsThe prospective cohort study was from the third examination cycle of the Uppsala Longitudinal Study of Adult Men, a population-based survey of elderly men ages 70-71 years; insulin sensitivity was assessed by glucose disposal rate as measured with euglycemic clamps. Inclusion criterion was eGFR<60 ml/min per 1.73 m(2) (n=543). Exclusion criteria were incomplete data on euglycemic clamp and diabetes (n=97), leaving 446 men with CKD stages 3 and 4 (eGFR median=51.9 ml/min per 1.73 m(2); range=20.2-59.5 ml/min per 1.73 m(2)).ResultsThe mean of glucose disposal rate was 5.41.9 mg/kg per minute. In multivariable analysis, the independent clinical correlates of glucose disposal rate were eGFR (slope, 0.02; 95% confidence interval, 0.01 to 0.04), hypertension (-0.48; 95% confidence interval, -0.86 to -0.11), hyperlipidemia (-0.51; 95% confidence interval, -0.84 to -0.18), and body mass index (-0.32; 95% confidence interval, -0.37 to -0.27). During follow-up (median=10.0 years; interquartile range=8.7-11.0 years), 149 participants died. In Cox regression models, glucose disposal rate was not associated with all-cause or cardiovascular mortality. Multiplicative interactions (P<0.05) were observed between glucose disposal rate and physical activity or smoking in total mortality association. After subsequent stratification, glucose disposal rate was an independent correlate of all-cause mortality in smokers (adjusted hazard ratio, 0.72; 95% confidence interval, 0.54 to 0.96 per 1 mg/kg per minute glucose disposal rate increase) and physically inactive individuals (hazard ratio, 0.77; 95% confidence interval, 0.61 to 0.97) but not their counterparts.ConclusioneGFR, together with various components of the metabolic syndrome, contributed to explain the variance of insulin sensitivity in men with CKD stages 3 and 4. Insulin sensitivity was associated with a lower mortality risk in individuals who smoked and individuals who were physically inactive.

语种: 英语
项目资助者: Swedish Research Council ; Strategic Research Programme in Diabetes at Karolinska Institutet ; Swedish Heart-Lung Foundation ; Center for Gender Medicine ; Westman&prime ; s Foundation ; Baxter Healthcare Corporation
WOS记录号: WOS:000333836600011
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/61173
Appears in Collections:北京大学深圳医院_肾内科_期刊论文

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作者单位: 1.Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden
2.Karolinska Inst, Ctr Mol Med, SE-14186 Stockholm, Sweden
3.Karolinska Inst, Div Renal Med, Dept Clin Sci Intervent & Technol, SE-14186 Stockholm, Sweden
4.Karolinska Inst, Div Baxter Novum, Dept Clin Sci Intervent & Technol, SE-14186 Stockholm, Sweden
5.Chinese Acad Med Sci, Peking Union Med Coll Hosp, Dept Nephrol, Beijing 100730, Peoples R China
6.Peking Univ, Shenzhen Hosp, Div Nephrol, Shenzhen, Peoples R China
7.Uppsala Univ, Dept Publ Hlth & Caring Sci, Sect Geriatr, Uppsala, Sweden
8.Uppsala Univ, Dept Publ Hlth & Caring Sci Clin Nutr & Metab, Uppsala, Sweden

Recommended Citation:
Xu, Hong,Huang, Xiaoyan,Arnlov, Johan,et al. Clinical Correlates of Insulin Sensitivity and Its Association with Mortality among Men with CKD Stages 3 and 4[J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY,2014,9(4):690-697.
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