Nephrology Dialysis Transplantation, Vol 13, Issue 10 2566-2571, Copyright © 1998 by Oxford University Press
M Nowicki, F Kokot and A Surdacki
Background. Patients with renal failure are
characterized by impaired insulin-mediated glucose uptake. Insulin plays a
major role in the maintenance of phosphate homeostasis but it remains to be
determined whether in uraemia insulin-dependent renal and extrarenal
phosphate disposal is also affected. Methods. The
effects of hyperinsulinaemia on serum concentrations of phosphate, ionized
calcium and intact PTH as well as renal excretion of calcium and phosphate
was studied under euglycaemic conditions (glucose clamp technique) in
patients with advanced renal failure and in healthy subjects. Fifteen
patients with renal failure (mean serum creatinine 917 &mgr;mol/l) and
12 control subjects were included. All subjects underwent a 3-h euglycaemic
clamp with constant infusion of insulin (50
mU/m2/min) following a priming bolus. The urine was
collected for 3 h before and throughout the clamp. Results.
The tissue insulin sensitivity (M/I) was lower in patients with
renal failure than in control subjects (5.3±2.4
vs 6.7±1.8 mg/kg/min per mU/ml,
P=0.001) but the phosphate lowering action of insulin
was larger in patients with renal failure than in control subjects. Urinary
calcium excretion increased (P<0.05) and
phosphate excretion did not change during the clamp in both groups. Despite
a decrease of serum ionized calcium in the group of patients with renal
failure and no change in the control group, plasma PTH fell significantly
in both groups but this effect was still significant after 180 min only in
the renal failure group. A significant correlation was observed between
changes in serum phosphate and PTH induced by hyperinsulinaemia
(r=0.48, P<0.01).
Conclusions. Phosphate-lowering effect of insulin is
well preserved in severe renal failure despite the resistance to
insulin-stimulated glucose uptake. The decrease of serum PTH observed
during hyperinsulinaemia appears to be independent of serum ionized
calcium. Keywords: calcium; insulin; insulin
resistance; parathyroid hormone; phosphate
ORIGINAL ARTICLES
The influence of hyperinsulinaemia on calcium-phosphate metabolism in renal failure
Department of Nephrology, Silesian University School of Medicine, Francuska 24, 40-027 Katowice, Poland; Second Department of Cardiology, Medical College, Jagellonian University, Cracow, Poland; Corresponding author
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