Changes in glucose and insulin metabolism induced by dialysis in patients with chronic uremia

Abstract

The effect of repeated hemodialysis on glucose metabolism was studied in 10 patients with severe uremia. Carbohydrate metabolism was evaluated during the first dialysis and again in a subsequent dialysis (second, third or fourth dialysis). Dialysis was performed using a high bath glucose concentration ( 1500 mg. 100 cc. ) in both study periods. Improvement in carbohydrate metabolism was demonstrated in the second dialysis study period by a lower mean glucose during dialysis and by more rapid disappearance rate of glucose in the immediate postdialysis period. This improvement in carbohydrate metabolism was associated with an increase in both mean and maximum insulin levels during the second study period in 8 of the 10 patients. It is concluded that the carbohydrate intolerance associated with uremia is improved by hemodialysis. In the majority of the patients studied, this improvement was associated with a significant increase in circulating insulin levels. The increase in insulin levels in response to hyperglycemic stimulation after only one or two dialyses suggests the removal of a dialyzable substance that either inhibits insulin release or increases insulin degradation.