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- Title
Association of Longitudinal Trajectories of Insulin Resistance With Adverse Renal Outcomes.
- Authors
Yang, Seokhun; Kwak, Soongu; Song, You-Hyun; Han, Seung Seok; Lee, Hye Sun; Kang, Shinae; Lee, Seung-Pyo
- Abstract
<bold>Objective: </bold>To analyze the relationship between time-serial changes in insulin resistance and renal outcomes.<bold>Research Design and Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
CHRONIC kidney failure complications; CHRONIC kidney failure; GLOMERULAR filtration rate; KIDNEYS; QUESTIONNAIRES; INSULIN resistance; LONGITUDINAL method
- Publication
Diabetes Care, 2022, Vol 45, Issue 5, p1268
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc21-2521