Study of markers of atherosclerosis including insulin resistance in patients with chronic renal failure
Journal of Diabetes Mellitus
Objectives: The present study was designed to assess the markers of atherosclerosis including Insulin resistance (IR) in naïve patients with chronic renal failure (CRF). Methods: Eighty consecutive naïve patients with CRF were taken up for study. They were divided into non-diabetic group, Group A (N = 50) and diabetic group, Group B (N = 30). Twenty healthy individuals were taken as controls, Group C (N = 20). Patients undergoing renal replacement therapy, having chronic liver disease and with
... r disease and with concomitant acute or chronic infection were excluded from the study. Routine hemogram, fasting plasma glucose, fasting serum insulin, lipid profile, renal function tests, C-reactive protein (CRP), serum uric acid levels, ultrasound of abdomen and ultrasound B scan for carotid intima medial thickness (CIMT) were done for all patients and control. The data collected were analyzed to inter-correlate the parameters using SPSS 16. Results: On comparing parameters between the three groups, values of HOMA-IR, CRP, uric acid, VLDL and CIMT were significantly higher in Groups A and B than Group C whereas values of HOMA-B, HDL and LDL were lower in both groups A and Bas compared to group C. HOMA-IR had significant negative correlation with creatinine clearance ( Crcl) (r = −0.449, p = 0.01) in Group A and (r = −0.483, p = 0.007) in Group B. HOMA-IR had significant positive correlation with CIMT (r = 0.413, p = 0.03) in Group A and (r = 0.581, p = 0.001) in Group B. Crcl had significant negative correlation with CIMT(r = −0.375, p = 0.007) in Group A and (r = −0.705, p = 0.001) in Group B. Crclnegatively correlated with C-reactive protein (r = −0.460, p = 0.001) in Group A and (r = 0.431, p = 0.01) in Group B. HOMA-B positively correlated with Crcl (r = 0.667, p = 0.001) and also with CIMT (r = −0.531, p = 0.003) among Group B individuals. Conclusion: There is a significant increase in insulin resistance (IR) and β cell dysfunction in patients with CRF. Also IR linearly increases with reduction in renal function. CRP and uric acid are also significantly increased, reflecting the existence of a chronic inflammatory milieu in these patients. All these factors contribute to accelerated atherosclerosis, signifying CRF per se is independent risk factor for atherosclerosis.