Effect of Hemodialysis on Peripheral Glucose Metabolism of Patients with Chronic Renal Failure

Abstract

Glucose intolerance has been shown in patients with chronic renal failure (CRF), probably associated with insulin resistance in peripheral tissues. The present study was thus designed to investigate the effect of hemodialysis on peripheral muscle glucose metabolism of patients with CRF. Nine normal subjects and 6 patients with CRF were studied after an overnight fast (12-14 h) and during 3 h after ingestion of 75 g of glucose. Peripheral glucose metabolism was analyzed by the forearm technique to estimate the muscle exchange of substrates combined with indirect calorimetry. The CRF patients were studied before and after at least 1 month of hemodialysis treatment. Plasma glucose levels (arterial and venous) were higher in uremic patients before dialysis than in normal controls. After the dialysis therapy there was improvement in the glycemic profile of the CRF patients. Decreased forearm muscle glucose uptake was observed in the uremic patients before dialysis compared to the normal subjects (234 ± 71 vs. 858 ± 52 μmol/100 ml forearm-3 h, p < 0.05) with diminished nonoxidative glucose metabolism (128 ± 78vs.686 ± 58 μmol/100 ml forearm-3 hp < 0.05). After the hemodialysis treatment of the CRF patients, the forearm glucose uptake and the nonoxidative glucose metabolism increased significantly to values of 527 ± 64 and 384 ± 87 μmol/100 ml forearm · 3 h, respectively. Muscle glucose oxidation did not differ significantly between normals and CRF patients before and after dialysis, as well as the serum insulin levels. These data demonstrate that insulin resistance in the presence of chronic uremia is accompanied by impaired muscle glucose uptake and nonoxidative glucose metabolism, which are significantly improved by the hemodialysis treatment.

Changes in blood glucose and lactate concentrations with hemodialysis

“…During HD, there is a change in blood flow distribution, with a reduction in blood flow to the liver, muscle and heart, which may affect tissue glucose uptake 4 . On the other hand, key water‐soluble vitamins may be cleared during dialysis, which would include pyridoxine.…”

“…3 During HD, there is a change in blood flow distribution, with a reduction in blood flow to the liver, muscle and heart, which may affect tissue glucose uptake. 4 On the other hand, key water-soluble vitamins may be cleared during dialysis, which would include pyridoxine. Pyridoxine (Vitamin B6) may potentially alter glucose absorption in the gut, 5 and pyridoxine deficiency may affect key enzymes involved in glucose metabolism.…”