Chapter 9 - The Role of Insulin Resistance in the Cardiorenal Syndrome

Abstract

Diabetes contributes to a prooxidative and proinflammatory 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). The presence of both prediabetes and diabetes predisposes individuals to the development of the metabolic syndrome (e.g., cardiorenal metabolic syndrome), which is constituted by a constellation of maladaptive factors, including obesity, insulin resistance, hypertension, and dyslipidemia, along with microalbuminuria and/or reduced kidney function. In this context, the presence of insulin resistance and visceral adiposity, independent of the presence of diabetes, leads to an increased risk for kidney disease and progressive loss of kidney function. Whether there is a direct cause and effect relationship between insulin resistance, obesity, the cardiorenal metabolic syndrome, and progressive kidney disease or just the presence of known risk factors for initiation and progression of CKD (i.e., hypertension and diabetes) is unknown. However, there is growing evidence that suggests that obesity and insulin resistance directly contribute to CKD.