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Published ahead of print on March 5, 2008
Clinical Journal of the American Society of Nephrology
© 2008 American Society of Nephrology
doi: 10.2215/CJN.02730707
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Received July 9, 2007
Accepted on January 28, 2008

ORIGINAL ARTICLES

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

Carlos Lorenzo *1, Subrata D. Nath {dagger}, Anthony J.G. Hanley {ddagger}, Hanna E. Abboud {dagger}, and Steven M. Haffner *

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


1 To whom correspondence should be addressed. E-mail: lorenzo{at}uthscsa.edu.


  Abstract

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.




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