Fibroblast growth factor-23 is a strong predictor of insulin resistance among chronic kidney disease patients |
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Authors: | Ahmed Fayed Mahmoud M. El Nokeety Ahmed A. Heikal Dina O. Abdulazim Mervat M. Naguib |
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Affiliation: | 1. Nephrology Unit, Internal Medicine Department, School of Medicine, Cairo University, Cairo, Egypt;2. Internal Medicine Department, School of Medicine, Cairo University, Cairo, Egypt;3. Rheumatology and Rehabilitation Department, School of Medicine, Cairo University, Cairo, Egypt;4. Endocrinology Unit, Internal Medicine Department, School of Medicine, Cairo University, Cairo, Egypt |
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Abstract: | Insulin resistance (IR) is very common among chronic kidney disease (CKD) patients. Disturbance in mineral and bone metabolism (MBD) seems to play a role in the pathogenesis of insulin resistance. Fibroblast growth factor-23 (FGF23) is evolving as the most important link between MBD and many pathologic sequences of CKD. The aim was to evaluate IR in pre-dialysis CKD patients looking for a possible association to mineral metabolism among CKD patients. A total of 100 stage 3–5 CKD patients were selected beside 20 normal control subjects. Homeostatic model assessment of insulin resistance (HOMA-IR) was used to assess IR in selected cases. Both groups were compared for fasting blood glucose (FBG), fasting blood insulin (FBI), HOMA-IR, estimated glomerular filtration rate (eGFR), serum calcium (Ca), phosphorus (P), 25 hydroxy vitamin D (25 OH vit D), parathormone (PTH), and uric acid (UA). Correlation study between HOMA_IR and different studied parameters was performed. HOMA-IR is significantly higher in CKD (8.87?±?3.48 vs. 3.97?±?0.34 in CKD vs. control, respectively, p?.001). In addition CKD patients have significantly higher FGF23 (235?±?22.96 vs. 139?±?12.3?pg/mL, p?.001), PTH (76.9?±?15.27 vs. 47.9?±?2.52?pg/mL, p?.001), P (4.3?±?0.67 vs. 3.6?±?0.23?mg/dL, p?.001), and UA (5?±?1.22 vs. 4.85?±?0.48?mg/dL, p?.001) and significantly lower Ca (8.2?±?0.3 vs. 8.9?±?0.33?mg/dL, p?.001), and 25 (OH) vit D (17?±?5.63 vs. 37?±?3.43?ng/mL, p?.001). Stepwise linear regression analysis revealed that BMI, GFR, Ca, P, and FGF23 were the only significant predictors of HOMA IR. Increased IR in CKD is a consequence of the uremic status and is intimately associated with disturbed phosphate metabolism and FGF23. Further studies are needed to look for an underlying mechanism. |
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Keywords: | FGF23 CKD-MBD insulin resistance HOMA-IR vitamin D 25 OH vitamin D |
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