Effect of angiotensin II receptor blockers on insulin resistance in maintenance haemodialysis patients

Abstract

Insulin resistance is a predictor of cardiovascular mortality in patients with end-stage renal disease. Although some clinical studies demonstrated that angiotensin II receptor blockers (ARB) improve insulin action in hypertensive patients, the role of ARB among patients with maintenance haemodialysis (MHD) remains controversial. The aim was to evaluate the effect of the ARB on insulin resistance in patients with MHD. The authors examined 10 patients with MHD who regularly underwent haemodialysis at least two visits per week. After 4, 8 and 12 weeks of treatment with valsartan, blood pressure monitoring, insulin resistance by homeostasis model assessment (HOMA-IR), fasting plasma glucose, fasting plasma insulin and blood chemistries were measured and compared with baseline values. Ten patients with MHD aged 16-74 years participated in the study. The causes of end-stage renal disease included hypertension (four cases), diabetes (three cases), glomerulonephritis (one case) and unknown cause (two cases). Fasting insulin levels significantly reduced from 11.9 +/- 5.7 microU/mL to 8.0 +/- 6.8 microU/mL (P < 0.001), and HOMA-IR decreased significantly from 3.6 +/- 2.5 to 2.1 +/- 1.6 (P = 0.005). Averaged pre- and post-haemodialysis systolic and diastolic blood pressure did not significantly change. The treatment did not significantly change the levels of uric acid, albumin and urea clearance, except for a significant decrease in total cholesterol, low-density lipoprotein and intact-parathyroid hormone. The insulin resistance in patients with MHD is controlled by valsartan. ARB that ameliorate insulin resistance and hyperinsulinaemia could also provide effective options for preventing cardiovascular disease in patients with MHD.