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KMID : 0359920140330040192
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Korean Journal of Nephrology
2014 Volume.33 No. 4 p.192 ~ p.198
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Insulin resistance is associated with new-onset cardiovascular events in nondiabetic patients undergoing peritoneal dialysis
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Yoon Chang-Yun
Lee Mi-Jung
Kee Youn-Kyung
Lee Eun-Young
Joo Young-Su
Han In-Mee
Han Seung-Gyu
Oh Hyung-Jung
Park Jung-Tak
Han Seung-Hyeok
Kang Shin-Wook
Yoo Tae-Hyun
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Abstract
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Background: Chronic exposure to high glucose-containing peritoneal dialysis solution and consequent abdominal obesity are potential sources of insulin resistance in patients requiring prevalent peritoneal dialysis. The aim of this study
was to elucidate the prognostic values of insulin resistance on new-onset cardiovascular events in nondiabetic patients undergoing prevalent peritoneal dialysis.
Methods: A total of 201 nondiabetic patients undergoing prevalent peritoneal dialysis were recruited. Insulin resistance was assessed by homeostatic model assessment of insulin resistance (HOMA-IR). The primary outcome was new-onset
cardiovascular events during the follow-up period. Cox proportional hazard analysis was performed to ascertain the independent prognostic value of HOMA-IR for the primary outcome.
Results: The mean age was 53.1 years and male was 49.3% (n=99). The mean HOMA-IR was 2.672.1. In multivariate linear regression, body mass index (β=0.169, P=0.011), triglyceride level (β=0.331, P<0.001), and previous cardiovascular
diseases (β=0.137, P=0.029) were still significantly associated with HOMA-IR. During a mean follow-up duration of 36.8716.2 months, the primary outcome was observed in 36 patients (17.9%). When patients were divided into tertiles
according to HOMA-IR, the highest tertile group showed a significantly higher incidence rate for new-onset cardiovascular events compared to the lower two tertile groups (P=0.029). Furthermore, multivariate Cox analysis revealed that
HOMA-IR was an independent predictor of the primary outcome (hazard ratio=1.18, 95% confidence interval=1.03?1.35, P=0.014).
Conclusion: Insulin resistance measured by HOMA-IR was an independent risk factor for new-onset cardiovascular events in nondiabetic patients undergoing prevalent peritoneal dialysis.
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KEYWORD
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Cardiovascular, Insulin resistance, Peritoneal dialysis
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