Title:Insulin Resistance is Associated with Subclinical Vascular Injury in Patients with a Kidney Disease
Volume: 17
Issue: 5
Author(s): María M. Adeva-Andany*, Carlos Fernández-Fernández, Lucía Adeva-Contreras, Natalia Carneiro-Freire, Alberto Domínguez-Montero and David Mouriño-Bayolo
Affiliation:
- Nephrology Division, Department of Internal Medicine, Hospital General Juan Cardona, c/ Pardo Bazán s/n 15406 Ferrol, A Coruña,Spain
Keywords:
Cardiovascular risk, arterial vasodilation, arterial stiffness, pulse pressure, left ventricular hypertrophy, arterial
pressure, intima-media thickness, vascular calcification.
Abstract: Patients with kidney disease have a strikingly high cardiovascular risk in the absence of
conventional cardiovascular risk factors, including smoking or elevation of cholesterol associated
with low-density lipoprotein. Kidney failure remains independently associated with increased cardiovascular
risk in patients with diabetes, underlining the specific adverse influence of kidney disease
on cardiovascular risk. Vascular injury develops in asymptomatic patients with kidney failure
early in the course of the disease. Defective arterial vasodilation, increased arterial stiffness, increased
intima-media thickness, and vascular calcification develop in patients with kidney disease
long before clinical evidence of cardiovascular events. Even mildly reduced kidney function is associated
with a subclinical vascular disease, which is a predictor of worse cardiovascular outcome in
patients with kidney failure, similar to the general population and patients with diabetes. Insulin resistance
is a typical feature of kidney disease that occurs during the entire span of the disorder,
from mild dysfunction to the dialysis phase. Insulin resistance (or its clinical manifestations, the
metabolic syndrome or its components) is independently associated with a subclinical vascular injury
in patients with kidney disease. Additionally, the risk of developing incident kidney disease
and the rapid decline in kidney function is higher in patients with insulin resistance. Animal protein
consumption increases dietary acid load and intensifies insulin resistance. Consistently, meat
intake promotes diabetes, cardiovascular disease, and kidney failure, while the consumption of
plant-based food is protective against the development of the vascular disease. Insulin resistance is
a robust cardiovascular risk factor in the general population, patients with diabetes, and patients
with kidney disease.
