Insulin resistance in chronic kidney disease
Insulin resistance in chronic kidney disease
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DOI：
10.1111/nep.13147
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发表时间：
2017-11
期刊：
影响因子：
2.5
通讯作者：
Hong Xu;J. Carrero
中科院分区：
文献类型：
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作者：
Hong Xu;J. Carrero
本文综述了慢性肾脏疾病（CKD）患者的胰岛素抵抗（IR）。IR是一种靶组织对胰岛素不能正常反应的病理状态。IR被认为是CKD的结果，其患病率上升，特别是在CKD晚期。过去30年的人体和实验研究表明，导致IR的机制是复杂和多因素的，涉及受体后信号缺陷、不健康的生活方式、代谢性酸中毒、炎症、氧化应激、维生素D缺乏、贫血和尿毒症毒性。虽然高胰岛素正糖钳是金标准，但它在床边是不实用的，通过空腹血糖或胰岛素和口服葡萄糖耐量试验（OGTT）估计IR指数也能提供令人满意的CKD患者IR估计。IR可能在心脏代谢并发症的发生中发挥关键作用，但并非所有研究都将IR与心血管事件和死亡风险联系起来。生活方式改变、透析治疗适应（如使用基于碘糊精的溶液）和噻唑烷二酮或维生素D治疗等药理学策略等各种干预措施可能改善CKD患者的IR。
This review provides an overview of insulin resistance (IR) in patients with chronic kidney disease (CKD). IR is a pathological state in which target tissues fail to respond normally to insulin. IR is understood as a consequence of CKD and its prevalence rises particularly in advanced CKD stages. Mechanisms leading to IR are complex and multifactorial, involving post‐receptor signaling defects, unhealthy lifestyles, metabolic acidosis, inflammation, oxidative stress, vitamin D deficiency, anemia, and uremic toxicity, as shown by human and experimental studies over the last 30 years. Whereas hyperinsulinemic euglycemic clamp is the gold standard, it is unpractical at the bedside, and either estimated IR indices by fasting glucose or insulin and oral glucose tolerance tests (OGTT) provide satisfactory estimates of IR also in patients with CKD. IR is likely to play a key role in the development of cardiometabolic complications, but not all studies associate IR with the risk of cardiovascular events and death. Various interventions at the level of lifestyle modifications, adaptations in dialysis therapy (such as use of icodextrin based solutions) and pharmacological strategies such as thiazolidinediones or vitamin D therapy may improve IR in patient with CKD.