Analysis Of The Incidence And Related Factors Of Insulin Resistance In Patients With Non-diabetic Nephropathy

Objective:1.To analyze the incidence of insulin resistance in 139 patients with non-diabetic nephropathy from March 2017 to March 2018 in the Renal Center of Yuxi people’s Hospital,sixth affiliated Hospital of Kunming Medical University.2.Study on ir related factors in patients with non-diabetic ckd in our centerMethods:A total of 139 non-diabetic ckd patients who were admitted to Yuxi people’s Hospital from March 2017 to March 2018 were analyzed,of which 137 cases were female and 182 cases were male,with an average age of 48.58 ± 15.73 years.Fasting blood glucose,serum insulin,creatinine,uric acid,urea,calcium,phosphorus,iron,bicarbonate 25 hydroxyl vitamin D,thyroid work and so on were measured.The steady-state model evaluation index was calculated as an index of insulin resistance.According to the standard,the subjects were divided into two groups:insulin resistance group(IR>2.0)and non insulin resistance group(IR<2).Results:1.The incidence of IR in the CKD 1-5 phase in this center was 21%、35%、30%、26%、25%,respectively,and there was no statistical difference in IR incidence between the two groups(P = 0.581).In the hemodialysis group(HD),the abdominal dialysis group(PD)and non-dialysis group(ND)were 25%、21%and 26%,respectively.There was no significant difference in the incidence of IR between the two groups(P = 0.794).The incidence of IR in each age group(<30 years old or 60 years old,≥ 60 years old)was 20%、28%and 22%,respectively.There was no significant difference in IR incidence rate among the three groups(P=0.398).The incidence of IR in male and female groups was 21%and 31%,respectively.There was no significant difference in IR incidence between the two groups(P= 0.061).2.Correlation analysis showed that BMI(r = 0.320,P = 0.001),calcium(r = 0.189,P = 0.001),triglyceride(r = 0.253,P = 0.001)were positive corrlated with the IR index;hemoglobin(r =-0.16,P = 0.004),iron(r =-0.223,P = 0.001),total cholesterol(r =-0.117,P = 0.001)were negatively correlated with the HOMA-IR index.Residual index were uncorrlated with the IR index.3.Further binary Logistic regression analysis:The Normal triglyceride(B=-1.022、OR=0.360、P=0.001),normal body mass index(BMI)(B=-1.301、OR=0.272、P=0.004)and no anemia(B=-1.201、OR=0.301、P=0.001)are the protective factors of insulin resistance,and the metabolic acidosis(B=1.835、OR=6.264、P=0.025)is a risk factor of insulin resistance.4.Comparison of Clinical Indexes between Insulin Resistance and Non-Insulin Resistance,The levels of triglyceride and serum calcium in insulin resistance group were significantly higher than those in non-insulin resistance group(P<0.05),The level of bicarbonate in the insulin resistance group was significantly lower than that of the non insulin resistance group(P<0.01),and there was no statistical difference in other indexes between the two groups(P>0.05).5.The incidence of IR in vitamin D deficiency group(44%)was significantly higher than that of normal vitamin D group(21%)(x2=8.391,P =0.004).25(OH)D and IR index was negative correlation(r =-0.236,P=0.006).Binary Logistic regression show:25(OH)D deficiency was risk factors of occuring IR(B=1.109,P=0.004,OR=3.032).The level of 25(OH)D in insulin resistance group was significantly lower than that in non insulin resistance group(P<0.001).6.FT3、FT4、TSH and IR index Correlation analysis show:There was no significant difference FT3(r=0.113,P=0.187),FT4(r=0.057,P=0.506),TSH(r=-0.118,P=0.169)with IR index,and level of FT3,FT4 and TSH was no significant difference between insulin resistance group and non insulin resistance group(P>0.05).Conclusions:1.There was insulin resistance in all stages of CKD but there was no difference in IR incidence in each stage.After grouping,there was no significant difference in insulin resistance among different genders in hemodialysis,peritoneal dialysis,non dialysis and age.2.Triglyceride,calcium and IR index were positively correlated,25(OH)D,bicarbonate,iron and total cholesterol were negatively correlated with IR index.3.Normal triglyceride,no anemia and normal body mass index are protective factors for insulin resistance.metabolic acidosis and 25(OH)D deficiency are risk factors of insulin resistance.4.The levels of triglyceride and serum calcium in insulin resistance group were significantly higher than those in non insulin resistance group.And the level of bicarbonate,25(OH)D and hemoglobin was significantly lower than that of non-insulin resistance group.5.There is no correlation between the index of FT3,FT4,TSH and the IR index in this study,and they was no significant difference between insulin resistance group and non insulin resistance group.