대한민국 비당뇨 성인에서 만성신장질환과 인슐린저항성 및베타세포기능의 관련성
The Relationship between the Progression of Chronic Kidney Disease and Beta Cell Function in Non-Diabetic Korean Adults
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
본 연구의 목적은 대한민국 20세 이상(50.32±16.14세)의 당뇨질환이 없는 성인에서 만성신장질환과 인슐린저항성(ho-meostasis model assessment of insulin resistance, HOMA-IR) 및 베타세포기능(homeostasis model assessment of beta cell function, HOMA-B)의 관련성에 대하여 조사하였다. 본 연구는 2015년도 국민건강영양조사 자료를 이용하여 당뇨질환이 없는 20세 이상의 대한민국 성인 4,380명을 대상으로 하였다. 본 연구결과에서 중요한 결과는 다음과 같다. 첫째, 만성신장질환과 HOMA-IR와 관련하여, 관련변수를 보정한 후의 결과에서(Model 4), 그룹 1 (G1; estimated glomerular filtrationrate [eGFR], ≥90 mL/min/1.73 m2), 그룹 2 (G2; eGFR, 60∼89 mL/min/1.73 m2), 그룹 3a (G3a; eGFR, 30∼59 mL/min/1.73 m2), ≥그룹 3b (≥G3b; eGFR, ＜30 mL/min/1.73 m2)의 HOMA-IR 평균값(M±SE, 95% confi-dence interval [CI])은 각각 1.78±0.03 (1.73∼1.83), 1.87±0.03 (1.81∼1.93), 2.16±0.13 (1.91∼2.42) 및 2.59±0.24 (2.12∼3.06)으로 만성신장질환이 진행됨에 따라 HOMA-IR은 증가하였다(P＜0.001). 둘째, 만성신장질환과 HOMA-B와 관련하여, 관련변수를 보정한 후의 결과에서(Model 4), G1, G2, G3a 및 ≥G3b의 HOMA-B 평균값(M±SE, 95% CI)은 각각 87.46±1.21 (85.08∼89.84), 89.11±1.38(86.40∼91.81), 104.82±5.91 (93.23∼116.42) 및 123.97±10.87 (102.66∼145.29)으로 만성신장질환이 진행됨에 따라 HOMA-B도 증가하였다(P＜0.001). 대한민국 당뇨질환이 없는 성인에서 만성신장질환이 진행됨에 따라 인슐린저항성이 증가하였고, 베타세포기능 또한 증가하였다.
Abstract
This study examined the relationship between chronic kidney disease (CKD) and the homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B) in non- diabetic Korean adults. This study included 4,380 adults aged 20 or older (50.32±16.14) using the 2015 Korea National Health and Nutrition Examination Survey (KNHANES) data, which represents the national data in Korea. The present study had several key findings. First, in terms of HOMA-IR, after adjusting for the related variables (Model 4), the HOMA-IR (M±SE, 95% confidence interval [CI]) in group 1 (G1; estimated glomerular filtration rate [eGFR], ≥90 mL/min/1.73 m2), group 2 (G2; eGFR, 60∼89 mL/min/1.73 m2), group 3a (G3a; eGFR, 30∼59 mL/min/1.73 m2), and ≥group 3b (≥G3b; eGFR, ＜30 mL/min/1.73 m2) were 1.78±0.03 (1.73∼1.83), 1.87±0.03 (1.81∼1.93), 2.16±0.13 (1.91∼2.42), and 2.59±0.24 (2.12∼3.06), respectively. The HOMA-IR was positively associated with the progression of CKD (P＜0.001). Second, in terms of the HOMA-B, after adjusting for the related variables (Model 4), the HOMA-B (M±SE, 95% CI) in G1, G2, G3a, and ≥G3b were 87.46±1.21 (85.08∼89.84), 89.11±1.38 (86.40∼91.81), 104.82±5.91 (93.23∼116.42), and 123.97±10.87 (102.66∼145.29), respectively. HOMA-B was positively associated with the progression of CKD (P＜0.001). Both insulin resistance and the beta-cell function were positively associated with CKD in non-diabetic Korean adults.
참고문헌 (21)
- "Chronic kidney disease" (2015)[URL]
- Vanholder R, "Chronic kidney disease as cause of cardiovascular morbidity and mortality", Nephrol Dial Transplant, 20, pp.1048~1056 (2005)[DOI]
- Jiayu Duan, "Prevalence and risk factors of chronic kidney disease and diabetic kidney disease in Chinese rural residents: a cross-sectional survey", Scientific Reports, 9(1), pp.10408~ (2019), Springer Science and Business Media LLC[DOI]
- Martin BC, "Role of glucose and insulin resistance in development of type 2 diabetes mellitus : results of a 25-year followup study", Lancet, 340, pp.925~929 (1992)[DOI]
- R. A. DeFronzo, "Insulin Resistance: A Multifaceted Syndrome Responsible for NIDDM, Obesity, Hypertension, Dyslipidemia, and Atherosclerotic Cardiovascular Disease", Diabetes Care, 14(3), pp.173~194 (1991), American Diabetes Association[DOI]
- Chunguang Chen, "Human beta cell mass and function in diabetes: Recent advances in knowledge and technologies to understand disease pathogenesis", Molecular Metabolism, 6(9), pp.943~957 (2017), Elsevier BV[DOI]
- Simona Cernea, "Diabetes and beta cell function: from mechanisms to evaluation and clinical implications", Biochemia Medica, 23, pp.266~280 (2013), Croatian Society for Medical Biochemistry and Laboratory Medicine[DOI]
- Page KA, "Interventions to preserve beta-cell function in the management and prevention of type 2 diabetes", Curr Diab Rep, 13, pp.252~260 (2013)[DOI]
- D. R. Matthews, "Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in man", Diabetologia, 28(7), pp.412~419 (1985), Springer Science and Business Media LLC[DOI]
- Neha Srivastava, "Insulin resistance in predialytic, nondiabetic, chronic kidney disease patients: A hospital-based study in Eastern Uttar Pradesh, India", Saudi Journal of Kidney Diseases and Transplantation, 28(1), pp.36~43 (2017), Medknow[DOI]
- Jing Chen, "Insulin Resistance and Risk of Chronic Kidney Disease in Nondiabetic US Adults", Journal of the American Society of Nephrology, 14(2), pp.469~477 (2003), American Society of Nephrology (ASN)[DOI]
- Trirogoff ML, "Body mass index and fat mass are the primary correlates of insulin resistance in nondiabetic stage 3-4 chronic kidney disease patients", Am J Clin Nutr, 86, pp.1642~1648 (2007)[DOI]
- Edmund J. Lewis, "The Effect of Angiotensin-Converting-Enzyme Inhibition on Diabetic Nephropathy", New England Journal of Medicine, 329(20), pp.1456~1462 (1993), Massachusetts Medical Society[DOI]
- F. A. El-Atat, "The Relationship between Hyperinsulinemia, Hypertension and Progressive Renal Disease", Journal of the American Society of Nephrology, 15(11), pp.2816~2827 (2004), American Society of Nephrology (ASN)[DOI]
- Akira Mima, "Retinal Not Systemic Oxidative and Inflammatory Stress Correlated with VEGF Expression in Rodent Models of Insulin Resistance and Diabetes", Investigative Opthalmology & Visual Science, 53(13), pp.8424~8432 (2012), Association for Research in Vision and Ophthalmology (ARVO)[DOI]
- S. Deng, "Structural and Functional Abnormalities in the Islets Isolated From Type 2 Diabetic Subjects", Diabetes, 53(3), pp.624~632 (2004), American Diabetes Association[DOI]
- Jenny E. Gunton, "Loss of ARNT", HIF1β Mediates Altered Gene Expression and Pancreatic-Islet Dysfunction in Human Type 2 Diabetes, 2005, pp.122(3), 337~349[DOI]
- Hien Pham, "Chronic Kidney Disease, Insulin Resistance, and Incident Diabetes in Older Adults", Clinical Journal of the American Society of Nephrology, 7(4), pp.588~594 (2012), American Society of Nephrology (ASN)[DOI]
- T. M. Wallace, "Use and Abuse of HOMA Modeling", Diabetes Care, 27(6), pp.1487~1495 (2004), American Diabetes Association[DOI]
- Hien Pham, "Measurement of insulin resistance in chronic kidney disease", Current Opinion in Nephrology and Hypertension, 20(6), pp.640~646 (2011), Ovid Technologies (Wolters Kluwer Health)[DOI]
- Belinda Spoto, "Insulin resistance in chronic kidney disease: a systematic review", American Journal of Physiology-Renal Physiology, 311(6), pp.F1087~F1108 (2016), American Physiological Society[DOI]