Insulin Resistance and Insulin Handling in Chronic Kidney Disease

Authors

Vishnu P Parvathareddy
Jiao Wu
Sandhya S Thomas

Publication Date

9-28-2023

Journal

Comprehensive Physiology

DOI

10.1002/cphy.c220019

PMID

37770191

PMCID

PMC11079812

PubMedCentral® Posted Date

5-9-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Insulin Resistance, Insulin, Renal Insufficiency, Chronic, Kidney, Disease Progression, Glomerular Filtration Rate

Abstract

Insulin regulates energy metabolism involving multiple organ systems. Insulin resistance (IR) occurs when organs exhibit reduced insulin sensitivity, leading to difficulties in maintaining glucose homeostasis. IR ensures decades prior to development of overt diabetes and can cause silent metabolic derangements. IR is typically seen very early in the course of chronic kidney disease (CKD) and is evident even when the estimated glomerular filtration rate (eGFR) is within the normal range and IR persists at various stages of kidney disease. In this article, we will discuss insulin handling by the kidneys, mechanisms responsible for IR in CKD, measurements and management of IR in patients with CKD, and recent type 2 diabetic trials with implications for improved cardiovascular outcomes in CKD.