Abstract: TH-PO434

Lipidogenic Actions of Insulin in Patients with CKD

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Alsouqi, Aseel, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Deger, Serpil muge, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Sha, Feng, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Bian, Aihua, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Ellis, Charles D., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Hung, Adriana, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Resistance to the metabolic actions of insulin is common in patients with CKD. We examined the acute effects of hyperinsulinemia on free fatty acid (FFA) levels during hyperinsulinemic euglycemic clamp (HEGC) study in patients with CKD and controls without kidney disease.

Methods

All participants underwent HEGC, where a fixed insulin infusion was started to achieve hyperinsulinemia with subsequent IV dextrose administration to maintain euglycemia (steady state). Peripheral resistance to insulin actions on glucose was assessed by Glucose Disposal Rate (GDR). Free fatty acid levels were measured at baseline and during steady state.

Results

We studied 165 individuals; 73 controls (59% females, 51% AA, median age 50 [IQR 38,65]) and 92 patients with CKD (31.5% females, 51% AA, median age 60, IQR[46,67]). FFA levels decreased similarly in response to insulin in all four groups: 88% in the control group, 89% in CKD Stages 3-4, 90% in HD and 86% in PD patients (p < 0.05 only for PD vs controls). Higher body mass index, fat mass, lean mass and Leptin Adiponectin Ratio were associated with lower rates of decrease in FFA levels. Increased age, higher baseline FFA levels, higher baseline adiponectin, higher GDR were significantly associated with higher rate of decrease in FFA levels. Leptin, C- reactive protein and interleukin-6 were not significantly associated with the change in FFA.

Conclusion

Body composition and adipocytokines are the primary determinants of actions of insulin on FFA metabolism in CKD patients. Patients on PD might have an underlying abnormality related to FFA metabolism, potentially related to excessive glucose exposure.

Correlations of different variables with the ratio of change in FFA levels during HEGC
VariableRhop value
BMI0.263<0.001
Fat Mass0.2660.022
Lean Mass0.404<0.001
LAR0.583<0.001
Age-0.1690.035
Baseline FFA-0.377<0.001
Adiponectin-0.705<0.001
GDR-0.363<0.001
Leptin0.1790.107
CRP-0.0760.446
IL-60.030.837

Funding

  • NIDDK Support