Chapter 11 - The Role of Insulin Resistance in the Cardiorenal Syndrome

Abstract

Diabetes is associated with an increased pro-oxidative and pro-inflammatory state that conveys an increased risk for cardiovascular end points such as cerebrovascular disease, ischemic heart disease, congestive heart failure, peripheral vascular disease, and chronic kidney disease (CKD). Both prediabetes and diabetes predispose to development of the cardiorenal metabolic syndrome, which is constituted by a group of interactive maladaptive factors including insulin resistance, hypertension, metabolic dyslipidemia, obesity, microalbuminuria and/or reduced renal function. In this regard, the presence of insulin resistance, hypertension, and visceral adiposity, independent of the presence of diabetes, leads to an increased risk for kidney disease and progressive loss of renal function. Whether there is a direct cause and effect relationship between the insulin resistance and obesity, the cardiorenal syndrome, and progressive kidney disease or just the presence of known risk factors for initiation and progression of CKD (i.e. hypertension and diabetes mellitus), is unknown. However, there is growing evidence that suggests that the obesity and insulin resistance directly contribute to CKD.