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NDT Advance Access originally published online on April 16, 2007
Nephrology Dialysis Transplantation 2007 22(9):2554-2562; doi:10.1093/ndt/gfm204
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Insulin resistance and muscle wasting in non-diabetic end-stage renal disease patients

Seoung Woo Lee1,3, Geun Ho Park1,3, Seung Won Lee1,3, Joon Ho Song1,3, Kee Chun Hong2,3 and Moon-Jae Kim1,3

1Division of Nephrology and Hypertension, Department of Internal Medicine, 2Department of Surgery and 3Kidney Disease Research Group, Inha University College of Medicine, Inchon, Korea

Correspondence and offprint requests to: Moon-Jae Kim, MD, Kidney Center, Inha University Hospital, 7-206, 3-Ga, Sinhung-Dong, Jung-Gu, Inchon city, Korea. E-mail: nhkimj{at}inha.ac.kr



  Abstract

Background. Insulin resistance (IR) is prevalent in uraemia. Recent experimental studies suggested IR to be a central mechanism for uraemic malnutrition. However, it is not known whether IR is related to muscle wasting in non-diabetic end-stage renal disease (ESRD) patients.

Methods. We cross-sectionally assessed IR and muscle wasting in 21 non-diabetic ESRD patients who admitted for the initiation of dialysis. For the assessment of muscle wasting, lean body mass was measured (LBMm) by dual energy X-ray absorptiometry and compared with the estimated LBM (LBMe) from the prediction equation derived from healthy controls using the ratio of LBMm/LBMe. For measurement of IR, the homoeostasis model (HOMA-IR) was used. In addition, among patients who chose continuous ambulatory peritoneal dialysis, muscle was sampled during catheter insertion from the rectus abdominis to measure 14-kDa actin fragments, a marker of muscle protein degradation.

Results. Patients with a low LBMm/LBMe ratio (<1.00) showed higher HOMA-IR and fat mass (FM) (% body weight) and lower LBM (% body weight) than those with a high LBMm/LBMe ratio (≥1.00). LBMm/LBMe ratio was negatively correlated with HOMA-IR, regardless of obesity. By multiple regression analysis, HOMA-IR was an independent factor affecting LBMm/LBMe ratio. Furthermore, in the muscle samples, patients with high HOMA-IR had lower LBMm/LBMe ratios and stronger bands for the 14-kDa actin fragments than did patients with low HOMA-IR.

Conclusion. These results suggest that IR seems to be associated with muscle wasting in non-diabetic ESRD patients.

Keywords: end-stage renal disease; insulin resistance; malnutrition; muscle atrophy

Received for publication: 24.12.05
Accepted in revised form: 15. 3.07


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