The Comparison of Insulin Sensitivity in Non-diabetic Hemodialysis Patients Treated with and without Recombinant Human Erythropoietin

Tuzcu, Alpaslan; Bahçeci, Mithat; Yılmaz, Emre; Bahçeci, Selen; Tuzcu, Şadiye Altun

doi:10.1055/s-2004-826021

Cited by 34 publications

(40 citation statements)

References 12 publications

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“…abnormalities and increased insulin sensitivity, with the duration of the treatment positively correlating with insulin sensitivity in these patients (188)(189)(190).…”

Section: Epo In Treatment Of Cardiovascular Diseasesmentioning

confidence: 99%

Epo and Non-hematopoietic Cells: What Do We Know?

Ogunshola

Bogdanova

2013

Methods in Molecular Biology

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“…abnormalities and increased insulin sensitivity, with the duration of the treatment positively correlating with insulin sensitivity in these patients (188)(189)(190).…”

Section: Epo In Treatment Of Cardiovascular Diseasesmentioning

confidence: 99%

Epo and Non-hematopoietic Cells: What Do We Know?

Ogunshola

Bogdanova

2013

Methods in Molecular Biology

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“…It may be that EPO itself is playing a role in lowering blood glucose levels. There has been some research suggesting that EPO increases insulin sensitivity (18). Lastly, there appears to be an interaction between the stage of chronic kidney disease (CKD) and the presence of diabetes in regard to hemoglobin, probably explained by endogenous EPO production.…”

Section: Multivariate Analysismentioning

confidence: 99%

Adequacy of Glycemic Control in Hemodialysis Patients With Diabetes

et al. 2006

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OBJECTIVE -We sought to measure the prevalence of inadequate glycemic control in prevalent hemodialysis patients with diabetes and to examine independent predictors of inadequate glycemic control in these patients. RESEARCH DESIGN AND METHODS-This is a cross-sectional study of prevalent hemodialysis patients with diabetes in southeastern Ontario (n ϭ 100). Data were collected by chart review and interview. The outcome variable was inadequate glycemic control defined as HbA 1c (A1C) Ͼ0.07. Other measured variables were diabetes type, diabetes duration, diabetes physician, blood glucose monitoring, diabetes medications, BMI, time on dialysis, and other demographic, clinical, and laboratory variables.RESULTS -Fifty-four patients had A1C Ͼ0.07. In bivariate analysis, these patients had a longer diabetes duration (23.6 vs.14.7 years, P Ͻ 0.001), higher proportion with insulin use (81.5 vs. 58.7%, P ϭ 0.012), higher proportion with microvascular complications (66.7 vs. 43.5%, P ϭ 0.017), and lower erythropoietin (EPO) dose (7.0 vs. 11.9 ϫ 10 3 units/week, P Ͻ 0.01) than patients with adequate glycemic control. There was no difference between the two groups in terms of macrovascular complications (59.3 vs. 65.2%, P ϭ 0.54). In multiple logistic regression controlling for age and diabetes type, the diabetes duration (odds ratio 1. showed that maintaining blood glucose at normal or near-normal levels can reduce the incidence of microvascular complications in patients with type 1 and type 2 diabetes, respectively (1,2). Both trials excluded patients with end-stage kidney disease (ESKD) from the study population. A significant percentage of diabetic patients have ESKD, however, and poor glycemic control has been shown to be a predictor of mortality in diabetic patients starting hemodialysis (3). Maintaining euglycemia may also be more difficult in patients with ESKD, as it has been suggested ESKD itself may induce insulin resistance (4).Using HbA 1c (A1C) as a marker of long-term glycemic control in patients with ESKD was problematic in the past, as carbamylated hemoglobin formed in the uremic milieu interfered with older assays that relied on ion exchange for determination of A1C (5,6). Newer chemical and immunoassays do not have this problem (7,8).A study conducted prior to the results of the DCCT and UKPDS trials did demonstrate an increase in both micro-and macrovascular complications in diabetic patients with poor glycemic control on chronic dialysis (hemodialysis or peritoneal dialysis) but utilized one of these older A1C assays (9). It also set a cutoff for adequate glycemic control of A1C Ͻ0.10, well above modern guidelines (10,11). Since the publication of the DCCT and UKPDS trials, there have been no studies showing how patients with diabetes on hemodialysis have fared in terms of adequacy of glycemic control and whether there are any differences between those who do and do not have adequate control.The primary objective of this study was to measure the prevalence of inadequate glycemic control in prevalent hemod...

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“…In that respect, we have been attracted by the reports of EPO effects on glucose metabolism in hemodialysis patients (Borissova et al 1993, Allegra et al 1996, which are associated with elevated insulin sensitivity (Spaia et al 2000, Tuzcu et al 2004. EPO effects were also documented on the metabolism of proteins and lipids; however, the latter are still controversial (reviewed in Allegra et al (1997)).…”

Section: Introductionmentioning

confidence: 99%

Erythropoietin treatment leads to reduced blood glucose levels and body mass: insights from murine models

Katz¹,

Stuible²,

Golishevski³

et al. 2010

Journal of Endocrinology

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Erythropoietin (EPO) regulates proliferation and differentiation of erythroid precursor cells into erythrocytes. The last decade has revealed non-renal sites of EPO production and extrahematopoietic expression of the EPO receptor, thus suggesting that EPO has pleiotropic functions. Here, we addressed the interplay between EPO/glucose metabolism/ body weight by employing a panel of relevant experimental murine models. The models focused on situations of increased EPO levels, including EPO-injected C57BL/6 and BALB/c mice, as well as transgenic mice (tg6) constitutively overexpressing human EPO, thus exposed to constantly high EPO serum levels. As experimental models for diabetes and obesity, we employed protein Tyr phosphatase 1B (PTP1B) knockout mice associated with resistance to diabetes (PTP1B K/K ), and ob/ob mice susceptible to diabetes and obesity. The data presented herein demonstrate EPOmediated decrease in blood glucose levels in all mice models tested. Moreover, in the ob/ob mice, we observed EPOmediated attenuation of body weight gain and reduction of hemoglobin A1c. Taken together, our data bear significant clinical implications of EPO treatment in the management of a wide range of metabolic diseases, thus adding an important novel therapeutic potential to this pleiotropic hormone.

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The Comparison of Insulin Sensitivity in Non-diabetic Hemodialysis Patients Treated with and without Recombinant Human Erythropoietin

Abstract: Firstly, patients treated with EPO are insulin sensitive compared to patients not treated with EPO. Secondly, duration of erythropoietin treatment is positively correlated with insulin sensitivity in hemodialysis patients.

Cited by 34 publications

References 12 publications

Epo and Non-hematopoietic Cells: What Do We Know?

Epo and Non-hematopoietic Cells: What Do We Know?

Adequacy of Glycemic Control in Hemodialysis Patients With Diabetes

Erythropoietin treatment leads to reduced blood glucose levels and body mass: insights from murine models

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