Hyperinsulinemia and Insulin Resistance in Pediatric Patients with Chronic Kidney Disease

Document Type : Original Article


The Department of Pediatrics*, Diagnostic & Interventional Radiology Department** and Clinical Pathology Department***, Faculty of Medicine, Ain Shams University


Abstract Background: Pediatric chronic kidney disease (CKD) is associated with disturbance of glucose metabolism & insulin receptor sensitivity leading to impaired glucose tolerance & insulin resistance (IR), which are potential risk factors for cardiovascular disease (CVD). Hyperinsulinemia and IR are not extensively investigated in children with CKD, especially in different stages of CKD. Aim of Study: Detect hyperinsulinemia & IR in pediatric CKD patients. Subjects and Methods: A total of 87 children and adoles-cents; 58 with chronic kidney disease (CKD); (29 CKD stage 2-4, pre-dialysis group & 29 CKD stage 5 on regular hemo-dialysis, CKD5d group) & 29 age & gender matched controls were enrolled in the current cross-sectional study. Homeostasis model assessment of insulin resistance (HOMA-IR) using fasting insulin & glucose, where IR was considered if HOMA-IR was ³4.39. Results: Fasting insulin & glucose hadn't significantly changed between CKD patients & controls (p=0.7, 0.3 respec-tively), while IR represented by HOMA-IR was found in a total of 11 (12.6%) CKD patients (6, 6.89% CKD5d & 5, 5.74% CKD 2-4) with no significant difference between pre-dialysis & dialysis groups (p>0.05), while it was significant with controls (p=0.039), meanwhile, the total means of HOMA-IR between were no statistically significant between all CKD patients & (p=0.64). HOMA-IR correlated positively to dialysis durations (p=<0.001, <0.001 respectively), but hadn't changed with BMI. Conclusion: Pre-dialysis & dialysis CKD pediatric patients are at a high risk of IR & hence CVD. CKD & dialysis durations are independent risk factors for IR.