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Association of Longitudinal Trajectories of Insulin Resistance With Adverse Renal Outcomes

Authors
 Seokhun Yang  ;  Soongu Kwak  ;  You-Hyun Song  ;  Seung Seok Han  ;  Hye Sun Lee  ;  Shinae Kang  ;  Seung-Pyo Lee 
Citation
 DIABETES CARE, Vol.45(5) : 1268-1275, 2022-05 
Journal Title
DIABETES CARE
ISSN
 0149-5992 
Issue Date
2022-05
MeSH
Female ; Glomerular Filtration Rate ; Humans ; Insulin Resistance* ; Kidney ; Male ; Prospective Studies ; Renal Insufficiency, Chronic* / complications ; Renal Insufficiency, Chronic* / epidemiology
Abstract
Objective: To analyze the relationship between time-serial changes in insulin resistance and renal outcomes.

Research design and methods: A prospective cohort of subjects from the general population without chronic kidney disease (CKD) underwent a biennial checkup for 12 years (n = 5,347). The 12-year duration was divided into a 6-year exposure period, where distinct HOMA for insulin resistance (HOMA-IR) trajectories were identified using latent variable mixture modeling, followed by a 6-year event accrual period, from which the renal outcome data were analyzed. The primary end point was adverse renal outcomes, defined as a composite of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in two or more consecutive checkups or albumin ≥1+ on urine strip.

Results: Two distinct groups of HOMA-IR trajectories were identified during the exposure period: stable (n = 4,770) and increasing (n = 577). During the event accrual period, 449 patients (8.4%) developed adverse renal outcomes, and the risk was higher in the increasing HOMA-IR trajectory group than in the stable group (hazard ratio 2.06, 95% CI 1.62-2.60, P < 0.001). The results were similar after adjustment for baseline clinical characteristics, comorbidities, anthropometric and laboratory findings, eGFR, and HOMA-IR. The clinical significance of increasing HOMA-IR trajectory was similar in three or four HOMA-IR trajectories. The increasing tendency of HOMA-IR was persistently associated with a higher incidence of adverse renal outcomes, irrespective of the prevalence of diabetes.

Conclusions: An increasing tendency of insulin resistance was associated with a higher risk of adverse renal outcomes. Time-serial tracking of insulin resistance may help identify patients at high risk for CKD.
Full Text
https://diabetesjournals.org/care/article/45/5/1268/144829/Association-of-Longitudinal-Trajectories-of
DOI
10.2337/dc21-2521
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Shin Ae(강신애) ORCID logo https://orcid.org/0000-0002-9719-4774
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/189557
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