Insulin resistance and hyperinsulinaemia in mild to moderate progressive chronic renal failure and its association with aerobic work capacity

Abstract

Summary Tissue sensitivity to insulin and aerobic work capacity was measured in patients with mild to moderate progressive chronic renal failure. Twentynine non-diabetic patients with a glomerular filtration rate of 25 ml-min -1 9 1.73 m -2 (11-43) (median, range) and 15 sex, age, and body mass index matched control subjects with normal renal function were studied. Fasting blood glucose was comparable and in the non-diabetic range in the two groups as was the oral glucose tolerance test. Patients demonstrated hyperinsulinaemia both during fasting (p < 0.01) and during the test (p < 0.02). The tissue sensitivity to insulin, expressed by the amount of glucose infused during the last 60 min of a 120-rain hyperinsulinaemia euglycaemic clamp (M-value) and the M/I ratio, was significantly lower in the patients than in the control subjects (M-value 404 + 118 vs 494 _+ 85 mg glucose/kg body weight, p < 0.02) (M/I ratio 1.77 + 0.71 vs 2.57 + 0.70 (mg/(kgBW -min) per pmol/1. 100, p < 0.001). The maximal aerobic work capacity was significantly lower in the patients than in the control subjects (24 + 8 vs 32 + 11 ml O2/(kg body weight-min), p < 0.02) and positively correlated to the M-value and the M/I ratio in both groups. In conclusion, not only patients with end-stage chronic renal failure but also those with mild to moderate progressive chronic renal failure are insulin resistant and hyperinsulinaemic. The tissue sensitivity to insulin is correlated to the maximal aerobic work capacity suggesting that these patients might benefit from physical training programmes. [Diabetologia (1995) 38: 565-572]

Vitamin D does not improve the metabolic health of patients with chronic kidney disease stage 3–4: A randomized controlled trial

“…Initial power calculations had been based on a true difference of 12% and within‐group standard deviation of 10%. However, the calculation was revised to reflect available data from the renal literature, but did not materially change the numbers needed. Thus, using independent t ‐testing with 1:1 randomization, an alpha of 0.05 and a within‐group standard deviation of 16.6%, 12 patients were required in each arm to detect a 20% difference in GDR with a power of 80%.…”

Validation of Simple Indices to Assess Insulin Sensitivity and Pancreatic Beta-Cell Function in Patients with Renal Dysfunction

“…The role of the kidney in the metabolism of insulin is well established, and reduced clearance rate of insulin has been demonstrated in patients with chronic renal failure. Although previous studies have demonstrated a link between insulin resistance (including hyperinsulinemia) and chronic renal failure [2, 3, 4, 10], most did not analyze for the influence of coexistent glucose intolerance. In this study, we carefully excluded the effects of glucose intolerance (IGT diagnosed by 75 g OGTT were excluded in our study), and we were unable to find any evidence of insulin resistance in the NGT-IRF group.…”

Impact of End‐Stage Renal Disease and Dialysis on Glycemic Control

“…Poor physical fitness may be a contributing factor for insulin resistance in ESRD patients (15). Long‐term exercise training in patients on hemodialysis, leading to enhanced exercise capacity, also results in normalization of hyperglycemia and glucose intolerance (16).…”