Hyperinsulinemia and insulin resistance, early cardiovascular risk factors in children with chronic kidney disease

Background/Aims: Pediatric chronic kidney disease (CKD) is associated with increased risk of cardiovascular disease. Still, hyperinsulinemia and insulin resistance, common cardiovascular risk factors, are not extensively investigated in children with CKD. We hypothesize that insulin abnormalities are present also in pediatric mild to moderate CKD, and associated with inflammation and malnutrition. Methods: We enrolled 26 children with CKD, and 34 healthy controls for analyses of blood samples and body composition. Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR). Results: The patients had higher insulin levels and HOMA-IR compared to the controls (p <0.01 and p <0.005), and they correlated inversely with estimated glomerular filtration rate (rho = -0.52, p <0.01; rho = -0.37, p = 0.08). No association was found with inflammation or malnutrition. Conclusion: High insulin levels and HOMA-IR appear to be common in pediatric CKD patients, already in mild to moderate renal failure. We hypothesize that hyperinsulinemia and insulin resistance alone might be important risk factors for cardiovascular disease in children with CKD.