The prevalence of insulin resistance and its relationship between anemia, secondary hyperparathyroidism, inflammation, and cardiac parameters in chronic hemodialysis patients.

BACKGROUND

Insulin resistance (IR) frequently accompanies end-stage renal disease (ESRD). There is a positive correlation between IR and cardiovascular pathologies that plays a role in mortality and morbidity on patients with ESRD. We aim to research the prevalence and evaluability of homeostasis model assessment-insulin resistance (HOMA-IR) in hemodialysis (HD) patients and also to evaluate the relationship of this value with various clinical parameters.

MATERIAL AND METHODS

57 ESRD patients, regularly undergoing HD were enrolled in the study. Obese patients (BMI > 25 kg/m2) and ESRD patients with diabetic etiology were excluded. Twenty-nine patients were men (50.9%), and 28 patients were women (48.1%); the mean age was 45.9 +/- 13.6 years. Results were recorded after evaluated by HOMA-IR. In addition to calculating the HOMA index, anthropometrical parameters, plasma levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), hematocrit (hct), parathyroid hormone (PTH), calcium (Ca), phosphorus (P), C-reactive protein (CRP), fasting glucose, and insulin plasma levels were measured by standard methods in all subjects. The systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were recorded, and left ventricle posterior wall thickness was measured by echocardiography. All patients completed the study. The minimum HOMA-IR value was 0.11, maximum value was 5.18, and the cut-off point was 1.23. According to this value, the patients were classified into two groups: HOMA-IR positive that were equal or higher than 1.23 (group 1), and HOMA-IR negative that were under this value (group 2).

RESULTS

We established that 18 of 57 (31.6%) patients were HOMA-IR positive and 39 of 57 (68.4%) patients were negative. In group 2, hct levels were higher than in group 1 and the weekly requiring dose of rHuEpo was significantly low in group 2 compared with group 1 (p < 0.05). Interestingly, the Ca x P products (> or =55 mg/dL) were significantly higher in group 2 than in group 1 (p < 0.05). There was not any significant correlation between HOMA-IR and anthropometrics measurements, hemodialysis adequacy, plasma PTH level, cardiac parameters, and inflammation markers. We established the prevalence of IR as 31.6% in our HD patients' cohort.

CONCLUSIONS

There was a positive correlation between low HOMA-IR value with target hct levels and administration of the rHuEpo. Because insulin resistance is an independent risk factor of cardiovascular mortality in ESRD patients, it was accepted that being able to correct the insulin resistance could be a novel therapeutic approach in this cohort.