The relationship between insulin resistance and left ventricular hypertrophy in patients with early chronic kidney disease / 中华内科杂志

ABSTRACT

Objective To analyze the relationship between insulin resistance (IR) and left ventricular hypertrophy ( LVH ) in patients with early chronic kidney disease ( CKD ). Methods Homeostatic model method was used for detecting insulin resistance index (Homa-IR) in 108 patients with early CKD and 25 normal healthy cases, and the other clinical data such as Hb, creatinine clearance rate (Ccr) , parathyroid hormone (PTH) , ambulatory blood pressure monitoring ( ABPM ) data, including day average systolic blood pressure (dSBP), day average diastolic blood pressure (dDBP), night average systolic blood pressure ( nSBP) , night average diastolic blood pressure ( nDBP) , 24-hour mean systolic blood pressure (mSBP), 24-hour mean diastolic blood pressure (mDBP), decline in the percentage of diastolic blood pressure at night (nDPD) and decline in the percentage of systolic blood pressure at night (nDPS) were also measured. Echocardiography was used for measuring LVH relevant data, and left ventricular mass index (LVMI) was calculated. Then, the relationship between LVH and IR and other clinical data were analyzed retrospectively. Results IR existed in early CKD patients. With the decline of Ccr, both the value of Homa-IR and the incidence of IR increased significantly (both P < 0. 05). LVH existed in early CKD patients and with the decline of Ccr, both LVMI value and the incidence of LVH increased significantly (both P <0. 01). Compared with the non-IR group, the IR group had higher LVMI value (P<0. 05) and higher incidence of LVH (P<0. 01). Compared with the non-LVH group, the LVH group had higher levels of Fins, 2hPG, Homa-IR (all P <0. 05), and higher incidence of IR (P <0. 01). The LVH group had significant lower levels of Ccr, Hb and nDPD (all P <0. 05) , higher levels of dSBP, dDBP, nSBP, nDBP, mSBP, mDBP and PTH (all P<0.05) than the non-LVH group. LVMI had significant positive correlations with 2hPG, Fins, Homa-IR, dSBP, nSBP, mSBP and PTH (r = 0.255, 0.373, 0.376,0.222,0.199,0.225,0.221,0.246, respectively; all P<0.05), but significant negative correlations with Hb and Ccr (r = -0.588,-0.313, respectively; both P<0.01). Multi-factor regression analysis showed that Hb, Homa-IR, and Ccr entered the regression equation (y = 167. 106 - 0. 755x_1 + 0. 250x_2 +0.322x_3, y = LVMI; 167. 106 = constant, t = 12. 138, P =0.000; x_1 =Hb, t= -6.800, P = 0. 000; x_2 = Homa-IR, t = 3. 229, P = 0. 002; x_3 = Ccr, t = 2. 898, P = 0. 005). Conclusion IR existed in early CKD patients and become more severe with the decline of renal function. IR had a significant correlation with LVH, and it may be an important risk factor for the development of LVH. Besides, both anemia and decline of renal function are also associated with LVH.