Kidney injury molecule (KIM)-1 is associated with insulin resistance: results from two community-based studies of elderly individuals.
BACKGROUND AND OBJECTIVES
Insulin resistance has been shown to be closely associated with glomerular filtration rate and urinary albumin/creatinine ratio, even prior to the development of diabetes. Urinary kidney injury molecule 1 (KIM-1) is a novel, highly specific marker of kidney tubular damage. The role of insulin resistance in the development of kidney tubular damage is not previously reported. Thus, we aimed to investigate the associations between insulin sensitivity (assessed by HOMA) and urinary KIM-1.


DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS
Two community-based cohorts of elderly individuals were investigated: Prospective Investigation of the vasculature in Uppsala seniors (PIVUS, n=701; mean age 75 years, 52% women); and Uppsala Longitudinal Study of adult men (ULSAM, n=533; mean age 78 years).


RESULTS
Lower insulin sensitivity was associated with higher urinary KIM-1 in both cohorts after adjustments for age, BMI, blood pressure, antihypertensive treatment, glomerular filtration rate, and urinary albumin-creatinine ratio (PIVUS: regression coefficient for 1-SD higher HOMA-IR 0.11, 95% CI 0.03-0.20, p=0.009, and ULSAM: 0.13, 95% CI 0.04-0.22, p=0.007). Results were similar in individuals without diabetes, with normal kidney function and normo-albuminuria.


CONCLUSIONS
Our findings in elderly individuals support the notion that the interplay between an impaired glucose metabolism and renal tubular damage is evident even prior to the development of diabetes and overt kidney disease.
['Carlsson|Axel C|AC|', 'Calamia|Michael|M|', 'Risérus|Ulf|U|', 'Larsson|Anders|A|', 'Helmersson-Karlqvist|Johanna|J|', 'Lind|Lars|L|', 'Arnlöv|Johan|J|']
D000328:Adult D000368:Aged D000419:Albuminuria D000959:Antihypertensive Agents D015415:Biomarkers D001794:Blood Pressure D055812:Community-Based Participatory Research D005260:Female D005500:Follow-Up Studies D005919:Glomerular Filtration Rate D000072596:Hepatitis A Virus Cellular Receptor 1 D006801:Humans D007333:Insulin Resistance D007674:Kidney Diseases D007684:Kidney Tubules D008137:Longitudinal Studies D008297:Male D008562:Membrane Glycoproteins D008875:Middle Aged D011446:Prospective Studies D011991:Receptors, Virus D012111:Residence Characteristics
Kidney injury Glomerular filtration Diabetes Blood glucose Microalbuminuria