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Abstract

Abnormalities of glucose metabolism and hyperinsulinemia have been demonstrated in patients with end-stage renal disease and may contribute to the development of atherosclerotic complications in these patients. This study was performed in hypertensive patients with mild to moderate impairment of renal function to investigate at what stage of renal failure abnormalities of glucose metabolism develop and whether these abnormalities are associated with increased prevalence of cardiovascular events. In 321 untreated essential hypertensive patients recruited at a hypertension clinic and 92 matched normotensive controls we assessed the renal function by measurement of 24-hour creatinine clearance, urinary protein excretion, and microalbuminuria, the cardiovascular status by clinical and laboratory tests, and measured plasma glucose, insulin, and C-peptide levels at fast and following a 75-g oral glucose tolerance test (OGTT). Patients with creatinine clearance less than 30 ml/min/1.73 m2, severe hypertension, obesity, and diabetes or family history of diabetes were excluded. Hypertensive patients had significantly greater fasting plasma insulin and C-petide levels and glucose and insulin responses to OGTT as compared to normotensive controls. In 116 of 321 hypertensive patients we found creatinine clearance less than 90 ml/min/1.73 m2, which was caused by hypertensive nephrosclerosis. Analysis of patients with different degree of renal function impairment demonstrated increased plasma glucose response to OGTT, hyperinsulinemia, and decreased fasting glucose/insulin ratio only in those patients with creatinine clearance less than 50 ml/min/1.73 m2. Parameters of glucose metabolism were not correlated with creatinine clearance and microalbuminuria. Prevalence of atherosclerotic cardiovascular events was significantly related to reduction of creatinine clearance, but parameters of glucose metabolism were comparable in patients with and without evidence of atherosclerotic damage. Thus, in patients with hypertensive nephrosclerosis and early impairment of glomerular filtration, alterations of glucose metabolism become evident only when creatinine clearance is less than 50 ml/min/1.73 m2 and do not seem to be related to microalbuminuria and cardiovascular complications.

nephroangiosclerosis, glucose metabolism, microalbuminuria
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© American Journal of Hypertension, Ltd. 2001
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