Nephrol Dial Transplant (2000) 15: 65-70
© 2000 European Renal Association-European Dialysis and Transplant Association
Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis
1 Department of Nephrology, Shonan Kamakura General Hospital, Yamazaki Kamakura, 2 Division of Nephrology, Department of Medicine, NTT Kanto Teishin Hospital, Gotanda, Shinagawa and 3 First Department of Medicine, Teikyo University School of Medicine, Itabashiku, Tokyo, Japan
Correspondence and offprint requests to: Shuzo Kobayashi, MD, PhD., Department of Medicine, Shonan Kamakura General Hospital, 1202–1 Yamazaki Kamakura 247-8533, Japan.
Background. Insulin resistance contributes to the pathogenesis of atherosclerotic cardiovascular disease and, thus, has an important impact on the mortality of uraemic patients. Haemodialysis (HD) is known to improve insulin resistance observed in uraemia. However, it is not known whether continuous ambulatory peritoneal dialysis (CAPD) alleviates insulin resistance in adult uraemic patients. The objective of this study was to compare the effect of two different dialysis modalities, HD and CAPD, on insulin resistance in adult uraemic patients and to identify the possible predictive factors for changes in insulin resistance.
Methods. Insulin resistance was examined in 19 non-diabetic patients with end-stage renal disease (ESRD) before and after dialysis therapy (HD, n=10; CAPD, n=9), as well as in 10 healthy controls using the hyperinsulinaemic euglycaemic glucose clamp technique. The glucose disposal rate (GDR mg/kg/min) was used as an index of insulin sensitivity during the clamp technique. We also determined which of various biochemical parameters might be associated with change in insulin resistance by carrying out multiple logistic regression analysis.
Results. GDR was significantly lower (6.44±1.76) in ESRD subjects than in normal subjects (9.90±2.01). HD and CAPD therapies significantly normalized GDR from 6.53±1.84 to 9.74±2.88 and from 6.35±1.65 to 8.18±1.76 respectively. Multiple logistic regression analysis showed that changes in BUN, haematocrit and plasma bicarbonate were significant predictive factors for the change in insulin resistance.
Conclusion. CAPD therapy, in spite of its possible adverse effects in patients with atherosclerotic disease, has been shown to improve insulin resistance in adult uraemic patients, similarly to HD therapy.
Keywords: atherosclerosis; continuous ambulatory peritoneal dialysis; glucose metabolism; haemodialysis; insulin resistance; uraemia
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S.-H. Park and B. Lindholm DEFINITION OF METABOLIC SYNDROME IN PERITONEAL DIALYSIS Perit. Dial. Int., February 1, 2009; 29(Supplement_2): S137 - S144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. K. Sakkas, C. Karatzaferi, E. Zintzaras, C. D. Giannaki, V. Liakopoulos, E. Lavdas, E. Damani, N. Liakos, I. Fezoulidis, Y. Koutedakis, et al. Liver fat, visceral adiposity, and sleep disturbances contribute to the development of insulin resistance and glucose intolerance in nondiabetic dialysis patients Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2008; 295(6): R1721 - R1729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Biolo, M. Stulle, F. Bianco, G. Mengozzi, R. Barazzoni, A. Vasile, G. Panzetta, and G. Guarnieri Insulin action on glucose and protein metabolism during L-carnitine supplementation in maintenance haemodialysis patients Nephrol. Dial. Transplant., March 1, 2008; 23(3): 991 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C. Fortes, P. H. Versari, A. E.M. Stinghen, and R. Pecoits-Filho CONTROLLING INFLAMMATION IN PERITONEAL DIALYSIS: THE ROLE OF PD-RELATED FACTORS AS POTENTIAL INTERVENTION TARGETS Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S76 - S81. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Garcia-Lopez, J. J. Carrero, M. E. Suliman, B. Lindholm, and P. Stenvinkel RISK FACTORS FOR CARDIOVASCULAR DISEASE IN PATIENTS UNDERGOING PERITONEAL DIALYSIS Perit. Dial. Int., June 1, 2007; 27(Supplement_2): S205 - S209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Yamauchi, T. Kuno, H. Takada, Y. Nagura, K. Kanmatsuse, and S. Takahashi The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients Nephrol. Dial. Transplant., September 1, 2003; 18(9): 1842 - 1847. [Abstract] [Full Text] [PDF]
|
|