Study of markers of atherosclerosis including insulin resistance in patients with chronic renal failure

Abstract

Objectives: The present study was designed to assess the markers of atherosclerosis including Insulin resistance (IR) in na?ve patients with chronic renal failure (CRF). Methods: Eighty consecutive na?ve 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 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.