Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease

被引:299
作者
Shinohara, K
Shoji, T
Emoto, M
Tahara, H
Koyama, H
Ishimura, E
Miki, T
Tabata, T
Nishizawa, Y
机构
[1] Osaka City Univ, Grad Sch Med, Dept Metab Endrocrinol & Mol Med, Abeno Ku, Osaka 5458585, Japan
[2] Osaka City Univ, Grad Sch Med, Dept Nephrol, Osaka 5458585, Japan
[3] Osaka City Univ, Grad Sch Med, Dept Geriatr & Neurol, Osaka 5458585, Japan
[4] Inoue Hosp, Div Internal Med, Suita, Osaka, Japan
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2002年 / 13卷 / 07期
关键词
D O I
10.1097/01.ASN.0000019900.87535.43
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Insulin resistance is closely associated with atherosclerosis and cardiovascular mortality in the general population. Patients with end-stage renal disease (ESRD) are known to have insulin resistance, advanced atherosclerosis, and a high cardiovascular mortality rate. We evaluated whether insulin resistance is a predictor of cardiovascular death in a cohort of ESRD. A prospective observational cohort study was performed in 183 nondiabetic patients with ESRD treated with maintenance hemodialysis. Insulin resistance was evaluated by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels at baseline, and the cohort was followed for a mean period of 67 mo. Forty-nine deaths were recorded, including 22 cardiovascular deaths. Cumulative incidence of cardiovascular death by Kaplan-Meier estimation was significantly different between subjects in the top tertile of HOMA-IR (1.40 to 4.59) and those in the lower tertiles of HOMA-IR (0.28 to 1.39), and the hazard ratio (HR) was 2.60 (95% confidence interval [CI], 1.12 to 6.01; P=0.026) in the univariate Cox proportional hazards model. In multivariate Cox models, the positive association between HOMA-IR and cardiovascular mortality remained significant (HR, 4.60; 95% CI, 1.83 to 11.55; P=0.001) and independent of age, C-reactive protein, and presence of preexisting vascular complications. Further analyses showed that the effect of HOMA-IR on cardiovascular mortality was independent of body mass index, hypertension, and dyslipidemia. In contrast, HOMA-IR did not show such a significant association with noncardiovascular mortality. These results indicate that insulin resistance is an independent predictor of cardiovascular mortality in ESRD.
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页码:1894 / 1900
页数:7
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