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{"title":"Insulin Resistance and Insulin Handling in Chronic Kidney Disease.","authors":"Vishnu P Parvathareddy, Jiao Wu, Sandhya S Thomas","doi":"10.1002/cphy.c220019","DOIUrl":null,"url":null,"abstract":"<p><p>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. © 2023 American Physiological Society. Compr Physiol 13:5069-5076, 2023.</p>","PeriodicalId":10573,"journal":{"name":"Comprehensive Physiology","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079812/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Comprehensive Physiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/cphy.c220019","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PHYSIOLOGY","Score":null,"Total":0}
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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. © 2023 American Physiological Society. Compr Physiol 13:5069-5076, 2023.
慢性肾脏疾病的胰岛素抵抗和胰岛素处理。
胰岛素调节涉及多个器官系统的能量代谢。当器官表现出胰岛素敏感性降低，导致难以维持葡萄糖稳态时，就会发生胰岛素抵抗（IR）。IR确保了在显性糖尿病发展之前的几十年，并可能导致无声的代谢紊乱。IR通常在慢性肾脏疾病（CKD）的早期出现，即使估计的肾小球滤过率（eGFR）在正常范围内，并且IR在肾脏疾病的各个阶段持续存在，也很明显。在这篇文章中，我们将讨论肾脏对胰岛素的处理、CKD中IR的机制、CKD患者IR的测量和管理，以及最近的2型糖尿病试验，这些试验对改善CKD心血管预后有意义。©2023美国生理学会。Compr Physiol 13:5069-50762023。
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