HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.02730707v1 3/3/783    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lorenzo, C. Articles by Haffner, S. M. Search for Related Content PubMed PubMed Citation Articles by Lorenzo, C. Articles by Haffner, S. M.

Relation of Low Glomerular Filtration Rate to Metabolic Disorders in Individuals without Diabetes and with Normoalbuminuria

Carlos Lorenzo^*, Subrata D. Nath, Anthony J.G. Hanley, Hanna E. Abboud, and Steven M. Haffner^*

^* Department of Medicine, Division of Clinical Epidemiology, and Department of Medicine, Division of Nephrology, University of Texas Health Science Center, San Antonio, Texas; and Nutritional Sciences and Medicine and Leadership Sinai Centre for Diabetes, Mt. Sinai Hospital, and the University of Toronto, Toronto, Ontario, Canada

Correspondence: Dr. Carlos Lorenzo, Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78284-7873. Phone: 210-567-4799; Fax: 210-567-6955; E-mail: lorenzo{at}uthscsa.edu

Background and objectives: Microalbuminuria increases cardiovascular risk and is considered a metabolic disorder. Low glomerular filtration rate is also associated with increased cardiovascular risk, but the relation of low glomerular filtration rate to metabolic disorders is not well understood.

Design, setting, participants, & measurements: Designed as a cross-sectional, epidemiologic study, the Insulin Resistance Atherosclerosis Study was conducted in four centers: San Antonio (Texas), San Luis Valley (Colorado), and Oakland and Los Angeles (California). The Modification of Diet in Renal Disease equation was used to classify individuals without diabetes and with normoalbuminuria (n = 856; age 40 to 69 yr) by the presence or absence of low glomerular filtration rate (<60 ml/min per 1.73 m²). A direct marker of insulin resistance, the insulin sensitivity index, was measured by the frequently sampled intravenous glucose tolerance test.

Results: Low glomerular filtration rate was related to hypertension and the metabolic syndrome. Low glomerular filtration rate was associated with fasting insulin concentration and insulin sensitivity index. Low glomerular filtration rate was also associated with insulin concentration after adjustment for potential determinants of glomerular filtration rate but was not associated with insulin sensitivity index.

Conclusions: Low glomerular filtration rate is associated with increased insulin concentration in individuals without diabetes and with normoalbuminuria. Longitudinal analyses are needed to determine whether insulin concentration (insulin resistance) precedes the deterioration of renal function.