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( Changyun Yoon ),( Youn Kyung Kee ),( Eun Young Lee ),( Young Su Joo ),( In Mee Han ),( Seung Gyu Han ),( Mi Jung Lee ),( Hyung Jung Oh ),( Jung Tak Park ),( Seung Hyeok Han ),( Shin Wook Kang ),( Ta 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Chronic exposure of high glucose and consequent abdominal obesity might be a potential source of insulin resistance (IR) in prevalent peritoneal dialysis (PD) patients. Even though a small sample-sized study reported that IR was associated with cardiovascular morbidity and mortality, further clarifi cation about the clinical signifi cance of IR in this population is needed. The aim of this study was to elucidate the prognostic values of IR on new-onset cardiovascular events in non-diabetic, prevalent PD patients. Methods: Non-diabetic ESRD patients maintained PD more than 3 months were recruited and prospectively followed up. IR was assessed by homeostatic model assessment of insulin resistance (HOMA-IR) using fasting insulin and glucose levels. The primary outcomes were new cardiovascular events or death during follow-up period. Results: Among 201 subjects, male was 49.3% (n=99) and mean age was 53.1 years. Mean HOMA-IR was 2.58. HOMA-IR was positively associated with body mass index (BMI), serum calcium and triglyceride, and was negatively associated with HDL-cholesterol. In addition, previous cardiovascular diseases (CVD) were signifi cantly related with high HOMA-IR. In multivariate linear regression for the association of HOMA-IR with clinical and biochemical variables, BMI, systolic blood pressure, triglyceride and previous CVD were remained for association with HOM-IR. During a mean follow up of 40.2 months, thirty-six (17.9%) patients were developed new cardiovascular events. When divided into three groups according to HOMA-IR, highest tertile HOMA-IR group showed significantly higher cardiovascular outcomes compared to lower two-third group (p=0.014). Cox regression analysis revealed that HOMA-IR was an independent predictor after adjusting for demographic, biochemical and PD related parameters (OR=1.17, 95% confi dence interval: 1.04-1.33, p=0.011). Conclusions: IR measured by HOMA-IR is an independent risk factor for cardiovascular morbidity and mortality in non-diabetic and prevalent ESRD patients undergoing PD.