The influence of dialysis treatment on insulin resistance in patients with end-stage renal disease

Abstract

Objective To compare the effect of two different dialysis modalities, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) on insulin resistance in patients with adult end-stage renal disease (ESRD), and to identify the possible predictive factors for insulin resistance. Methods Fifteen non-diabetic patients with ESRD (ESRD group) were selected. Eight patients were treated with HD (HD group), and 7 patients were treated with CAPD (CAPD group). The insulin inhibition was examined by hyper insulin-euglycemic glucose clamp technique before and after dialysis treatment, and the glucose disposal rate (GDR) was used as an index of insulin sensitivity during the clamp technique. Meanwhile, 8 healthy controls were selected as control group. The biochemical parameters which might be associated with insulin resistance were determined by multiple linear regression. Results The GDR in control group was (9.93 ± 1.33) mg/(kg·min), in ESRD group was (6.44 ± 1.76) mg/(kg·min), and there was statistical difference (P <0.05). The GDR in HD group after treatment was increased from (6.53 ± 1.84) mg/(kg·min) to (9.74 ± 2.88) mg/(kg·min), and there was statistical difference (P<0.01). The GDR in CAPD group after treatment was increased from (6.35 ± 1.65) mg/(kg·min) to (8.18 ± 1.76) mg/(kg·min), and there was statistical difference (P <0.05). Multiple linear regression result showed that the levels of urea nitrogen, hematocrit and bicarbonate were significant predictive factors in insulin resistance (P <0.05). Conclusions CAPD and HD therapy can improve insulin resistance in adult patients with ESRD. Key words: Peritoneal dialysis, continuous ambulatory; Insulin resistance; Uremia; Hemodialysis; Glucose metabolism disorders