Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis

Kobayashi, Shuzo; Maejima, Syunichi; Ikeda, Toshio; Nagase, Mitsumasa

doi:10.1093/ndt/15.1.65

Cited by 105 publications

(65 citation statements)

References 33 publications

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“…10,11 Its known that initiation of dialysis therapy partially revert those disturbances. 12 However, initiation of PD adds potential harm related to the great glucose absorption from PD fluids that lead to worsening of insulin resistance, dyslipidemia and higher levels of HbA1c. In the present study we confirm that the glucose and lipid metabolism profile in PD patients is worse than the observed in their HD counterparts.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients

Fortes¹,

Ribeiro²,

Riella³

et al. 2011

J. Bras. Nefrol.

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ResumoObjetivo: O presente estudo foi desenhado pra investigar e comparar biomarcadores do metabolismo de glicose e lipídeos em pacientes não diabéticos em diálise peritoneal e hemodiálise. Métodos: O estudo possui um desenho prospectivo e transversal. Participantes: foram incluídos todos os pacientes prevalentes em terapia de substituição renal tratados em uma clíni-ca universitária. Intervenções: não houve intervenções. Medida das variáveis principais: as amostras de sangue foram coletadas com jejum oral de 8 horas. Os níveis séricos de insulina foram determinados por quimioluminescência. Resistência insulínica foi avaliada pelo index QUICKI como se segue: 1/[log(Io) + log(Go)], onde Io é a insulina de jejum, e Go a glicemia de jejum. Índice HOMA também foi medido: (FPG × FPI)/22,5; FPG = glicemia de jejum (mmol/L); FPI = insulina de jejum (mU/mL). Os demais exames bioquímicos foram analisados utilizando métodos de rotina. Resultados: Foram avaliados 154 pacientes (80 em hemodiálise e 74 em diálise peritoneal). Setenta e quatro pacientes diabéticos foram excluídos. Dos 80 pacientes restantes (55% homens, idade média de 52 ± 15 anos), 35 estavam em diálise peritoneal e 45 em hemodiálise. A glicemia em jejum dos pacientes em diáli-se peritoneal em relação à hemodiálise foi 5,0 ± 0,14 versus 4,58 ± 0,14 mmol/L, p < 0,05; para hemoglobina glicada (HbA1c) de 5,9 ± 0,1 versus 5,5 ± 0,1%, p<0,05; colesterol total de 5,06 ± 0,19 versus 3,39 ± 0,20 mmol/L, p < 0,01; LDL-c de 2,93 ± 0,17 versus 1,60 ± 0,17 mmol/L, p < 0,01; e índice HOMA de 3,27 versus 1,68, p < 0,05. Todas as variáveis foram ajustadas para idade, sexo, tempo em diálise, produto cálcio-fósforo, albumina e proteína

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Section: Discussionmentioning

confidence: 99%

Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients

Fortes¹,

Ribeiro²,

Riella³

et al. 2011

J. Bras. Nefrol.

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“…After induction, peritoneal dialysis (PD) has been shown to initially improve insulin resistance in uremic patients, similar to hemodialysis (HD) (3). However, it is feared that with time the cumulative exposure to glucose solutions used in PD might lead to systemic hyperglycemia, obesity, and aggravate insulin resistance, which could contribute to increased cardiovascular risk (4).…”

Section: Introductionmentioning

confidence: 99%

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Bernardo

Oliveira

Santos³

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Insulin resistance has been associated with cardiovascular disease in peritoneal dialysis patients. Few studies have addressed the impact of fast transport status or dialysis prescription on insulin resistance. The aim of this study was to test whether insulin resistance is associated with obesity parameters, peritoneal transport rate, and glucose absorption.Design, setting, participants, & measurements Insulin resistance was evaluated with homeostasis model assessment method (HOMA-IR), additionally corrected by adiponectin (HOMA-AD). Enrolled patients were prevalent nondiabetics attending at Santo António Hospital Peritoneal Dialysis Unit, who were free of hospitalization or infectious events in the previous 3 months (51 patients aged 50.4615.9 years, 59% women). Leptin, adiponectin, insulin-like growth factor-binding protein 1 (IGFBP-1), and daily glucose absorption were also measured. Lean tissue index, fat tissue index (FTI), and relative fat mass (rel.FM) were assessed using multifrequency bioimpedance. Patients were categorized according to dialysate to plasma creatinine ratio at 4 hours, 3.86% peritoneal equilibration test, and obesity parameters.Results Obesity was present in 49% of patients according to rel.FM. HOMA-IR correlated better with FTI than with body mass index. Significant correlations were found in obese, but not in nonobese patients, between HOMA-IR and leptin, leptin/adiponectin ratio (LAR), and IGFBP-1. HOMA-IR correlated with HOMA-AD, but did not correlate with glucose absorption or transport rate. There were no significant differences in insulin resistance indices, glucose absorption, and body composition parameters between fast and nonfast transporters. A total of 18 patients (35.3%) who had insulin resistance presented with higher LAR and rel. FM (7.3 [12.3, interquartile range] versus 0.7 [1.4, interquartile range], P,0.001, and 39.4610.1% versus 27.2611.5%, P=0.002, respectively), lower IGFBP-1 (8.267.2 versus 21.0616.3 ng/ml, P=0.002), but similar glucose absorption and small-solute transport compared with patients without insulin resistance. FTI and LAR were independent correlates of HOMA-IR in multivariate analysis adjusted for glucose absorption and small-solute transport (r=0.82, P,0.001).Conclusions Insulin resistance in nondiabetic peritoneal dialysis patients is associated with obesity and LAR independent of glucose absorption and small-solute transport status. Fast transport status was not associated with higher likelihood of obesity or insulin resistance.

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“…Kobayashi et al showed that CAPD therapy with standard glucose containing solutions for 5.4 weeks normalized insulin resistance similar to hemodialysis therapy. [18] In contrast, Delarue reported that CAPD patients display an insulin resistance not explained by increased lipid oxidation. The maintenance of intracellular glucose utilization at the expense of higher glycemic and insulinemic responses suggests a defective glucose transport.…”

Section: Discussionmentioning

confidence: 98%

Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients

Canbakan

Sahin

2007

Renal Failure

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Insulin resistance is commonly observed in uremic patients. Glucose-based peritoneal dialysis solutions have long-term metabolic complications like hyperinsulinemia, hyperlipidemia, and obesity. The purpose of this study was to examine the insulin resistance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with standard glucose and icodextrin containing solutions. The entire non diabetic CAPD patients of our center were studied: forty-four patients in all who were on CAPD treatment for 36.2 ± 23.7 months. Twenty-seven of them (11 male and 16 female) with a mean age of 46 ± 16 years were treated with standard glucose solutions (glucose group). The other 17 patients (10 male and 7 female) with a mean age of 49 ± 16 years were treated with standard glucose solutions during the day and icodextrin dwell during the night, for a median of 12 ± 6.3 months (icodextrin group). Morning fasting serum insulin levels were 20.59 ± 17.86 in the glucose group and 10.15 ± 6.87 in the icodextrin group (p = 0.0001).Homeostasis Model Assessment Method scores of the glucose group were significantly higher (4.8±4.1 vs 2.3± 1.7; p = 0.025) than the icodextrin group. A significant positive correlation of HOMA score with insulin, fasting plasma glucose, and triglyceride levels were found in HOMA (IR+) patients. Twenty patients of the icodextrin group (74%) and 15 patients of the glucose group (88%) were hypertensive, but there was no statistically significant difference between the two groups (p = 0.13). The groups showed no significant differences for body mass index and serum levels of glucose, total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol, triglyceride, intact parathyroid hormone (iPTH), and fibrinogen. In conclusion, the use of icodextrin in the long nighttime dwell can reduce serum insulin levels and increase insulin sensitivity in CAPD patients.

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Impact of dialysis therapy on insulin resistance in end-stage renal disease: comparison of haemodialysis and continuous ambulatory peritoneal dialysis

Abstract: 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.

Cited by 105 publications

References 33 publications

Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients

Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients

Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients

Icodextrine and Insulin Resistance in Continuous Ambulatory Peritoneal Dialysis Patients

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