The Impact of Insulin Resistance and Chronic Kidney Disease on Inflammation and Cardiovascular Disease

There is extensive evidence showing that insulin resistance (IR) is associated with chronic low-grade inflammation. Furthermore, IR has been shown to increase the risk for cardiovascular disease (CVD), even in nondiabetic patients, and is currently considered as a “nontraditional” risk factor contributing to CVD by promoting hypertension, oxidative stress, endothelial dysfunction, dyslipidemia, and type 2 diabetes mellitus. However, chronic kidney disease (CKD) is also considered a state of low-grade inflammation. In addition, CKD is considered an IR state and has been described as an independent risk factor for the development of CVD, as even early-stage CKD is associated with an estimated 40% to 100% increase in CVD risk. There is also strong evidence indicating that inflammation per se plays a crucial role in both the initiation and progression of CVD. Given the above, the combined effect of IR and CKD may significantly increase the risk of inflammation and CVD. This review aims to focus on the complex interplay between IR, CKD, inflammation, and CVD and will present and discuss the current clinical and scientific data pertaining to the impact of IR and CKD on inflammation and CVD.

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Anemia as a Risk Factor for Cardiovascular Disease and All-Cause Mortality in Diabetes: The Impact of Chronic Kidney Disease

Journal of the American Society of Nephrology ◽

10.1681/asn.2005030226 ◽

2005 ◽

Vol 16 (11) ◽

pp. 3403-3410 ◽

Cited By ~ 166

Author(s):

Panagiotis T. Vlagopoulos ◽

Hocine Tighiouart ◽

Daniel E. Weiner ◽

John Griffith ◽

Dan Pettitt ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Risk Factor ◽

Kidney Disease ◽

All Cause Mortality ◽

The Impact

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The impact of a needs-oriented dental prophylaxis program on bacteremia after toothbrushing and systemic inflammation in children, adolescents, and young adults with chronic kidney disease

Pediatric Nephrology ◽

10.1007/s00467-021-05153-1 ◽

2021 ◽

Author(s):

Karolin Höfer ◽

Anna Turnowsky ◽

Rasmus Ehren ◽

Christina Taylan ◽

Georg Plum ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Systemic Inflammation ◽

Statistical Significance ◽

Bacterial Species ◽

Control Group ◽

Low Grade ◽

Dental Prophylaxis ◽

The Impact

Abstract Background Chronic kidney disease (CKD) still leads to high mortality rates, mainly due to cardiovascular disease. One important influencing factor is persisting low-grade chronic inflammation partly maintained by gingivitis that favors transient bacteremia during daily activities such as toothbrushing. Methods To examine whether intensive dental prophylaxis can restore oral health, reduce the prevalence of bacteremia and degree of systemic inflammation indicated by CRP levels, we conducted this pilot study examining 30 CKD patients aged 6–26 years, 15 receiving intensive prophylaxis (IP), 15 receiving treatment as usual (TAU) serving as control group. There were three appointments for examination, each 10 ± 1 weeks apart (at baseline, after intervention periods one and two, when TAU also received IP, and the IP group stopped prophylaxis). Results The gingival index (GI) in the IP group decreased by 90% (GI 0.09; p=0.001), resulting in almost healthy gingiva. There was no significant change in CRP or prevalence of bacteremia. General prevalence of bacteremia after toothbrushing was 9.5% affecting 7 (26%) of the participants. In three participants, bacteremia dissolved after IP, in one after TAU. Two patients developed bacteremia ≥ 10 weeks after ending IP. We identified eight different bacterial species. Conclusions We were able to show that IP can effectively treat gingivitis. It might be a promising approach to reduce systemic inflammation and subsequently lower premature cardiovascular disease, despite the lack of statistical significance. Future research requires a larger patient cohort to enable matched treatment groups with long-term follow-up and molecular detection methods for bacteremia. Graphical abstract

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Specific diseases: renal disease

ESC CardioMed ◽

10.1093/med/9780198784906.003.0643 ◽

2018 ◽

pp. 2670-2673

Author(s):

Susanna Price

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Risk Factor ◽

Kidney Disease ◽

Renal Disease ◽

Independent Risk Factor ◽

Hospital Admissions ◽

Kidney Injury ◽

Potential Methods

Chronic kidney disease is a global health burden, with an estimated prevalence of 11–13%, with the majority of patients diagnosed as stage 3, and is an independent risk factor for cardiovascular disease. The incidence of acute kidney injury is increasing, and estimated to be present in one in five acute hospital admissions, and there is a bidirectional relationship between acute and chronic kidney disease. The relevance to the patient with cardiovascular disease relates to increased perioperative risk, as reduced kidney function is an independent risk factor for adverse postoperative cardiovascular outcomes including myocardial infarction, stroke, and progression of heart failure. Furthermore, patients undergoing cardiovascular investigations are at risk of developing acute kidney injury, in particular where iodinated contrast is administered. This chapter reviews the classification of renal disease and its impact on cardiovascular disease, as well as potential methods for reducing the development of contrast-induced acute kidney injury.

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The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study

Diabetes Care ◽

10.2337/dc19-2137 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1750-1758

Author(s):

Eric Yuk Fai Wan ◽

Weng Yee Chin ◽

Esther Yee Tak Yu ◽

Ian Chi Kei Wong ◽

Esther Wai Yin Chan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Life Expectancy ◽

Direct Medical Cost ◽

Medical Cost ◽

The Impact

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Can we IMPROVE cardiovascular outcomes through phosphate lowering in CKD? Rationale and protocol for the IMpact of Phosphate Reduction On Vascular End-points in Chronic Kidney Disease (IMPROVE-CKD) study

BMJ Open ◽

10.1136/bmjopen-2018-024382 ◽

2019 ◽

Vol 9 (2) ◽

pp. e024382 ◽

Cited By ~ 8

Author(s):

Nicole Lioufas ◽

Nigel D Toussaint ◽

Eugenia Pedagogos ◽

Grahame Elder ◽

Sunil V Badve ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Arterial Compliance ◽

Left Ventricular ◽

Serum Phosphate ◽

Lanthanum Carbonate ◽

Cardiovascular Morbidity And Mortality ◽

Fgf 23 ◽

The Impact

IntroductionPatients with chronic kidney disease (CKD) are at heightened cardiovascular risk, which has been associated with abnormalities of bone and mineral metabolism. A deeper understanding of these abnormalities should facilitate improved treatment strategies and patient-level outcomes, but at present there are few large, randomised controlled clinical trials to guide management. Positive associations between serum phosphate and fibroblast growth factor 23 (FGF-23) and cardiovascular morbidity and mortality in both the general and CKD populations have resulted in clinical guidelines suggesting that serum phosphate be targeted towards the normal range, although few randomised and placebo-controlled studies have addressed clinical outcomes using interventions to improve phosphate control. Early preventive measures to reduce the development and progression of vascular calcification, left ventricular hypertrophy and arterial stiffness are crucial in patients with CKD.Methods and analysisWe outline the rationale and protocol for an international, multicentre, randomised parallel-group trial assessing the impact of the non-calcium-based phosphate binder, lanthanum carbonate, compared with placebo on surrogate markers of cardiovascular disease in a predialysis CKD population—the IMpact of Phosphate Reduction On Vascular End-points (IMPROVE)-CKD study. The primary objective of the IMPROVE-CKD study is to determine if the use of lanthanum carbonate reduces the burden of cardiovascular disease in patients with CKD stages 3b and 4 when compared with placebo. The primary end-point of the study is change in arterial compliance measured by pulse wave velocity over a 96-week period. Secondary outcomes include change in aortic calcification and biochemical parameters of serum phosphate, parathyroid hormone and FGF-23 levels.Ethics and disseminationEthical approval for the IMPROVE-CKD trial was obtained by each local Institutional Ethics Committee for all 17 participating sites in Australia, New Zealand and Malaysia prior to study commencement. Results of this clinical trial will be published in peer-reviewed journals and presented at conferences.Trial registration numberACTRN12610000650099.

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