Sit Dede, Kadiroglu Ali Kemal, Yilmaz Mehmet Emin, Kara Ismail Hamdi, Isikoglu Bünyamin
Department of Nephrology in Medicine Faculty, University of Dicle, Diyarbakir, Turkey.
Ren Fail. 2005;27(4):403-7.
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.
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).
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.
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.
胰岛素抵抗（IR）常伴随终末期肾病（ESRD）出现。IR与心血管病变之间存在正相关，这在ESRD患者的死亡率和发病率中起作用。我们旨在研究血液透析（HD）患者中稳态模型评估胰岛素抵抗（HOMA-IR）的患病率和可评估性，并评估该值与各种临床参数的关系。
本研究纳入57例定期接受HD的ESRD患者。排除肥胖患者（BMI>25kg/m²）和糖尿病病因的ESRD患者。29例患者为男性（50.9%），28例患者为女性（48.1%）；平均年龄为45.9±13.6岁。通过HOMA-IR评估后记录结果。除计算HOMA指数外，还采用标准方法测量了所有受试者的人体测量参数、总胆固醇、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、血细胞比容（hct）、甲状旁腺激素（PTH）、钙（Ca）、磷（P）、C反应蛋白（CRP）、空腹血糖和胰岛素血浆水平。记录收缩压、舒张压和平均动脉压，并通过超声心动图测量左心室后壁厚度。所有患者均完成研究。HOMA-IR最小值为0.11，最大值为5.18，切点为1.23。根据该值，将患者分为两组：HOMA-IR阳性组（等于或高于1.23，第1组）和HOMA-IR阴性组（低于该值，第2组）。
我们发现57例患者中有18例（31.6%）HOMA-IR阳性，57例中有39例（68.4%）阴性。在第2组中，hct水平高于第1组，与第1组相比，第2组每周所需的重组人促红细胞生成素（rHuEpo）剂量显著较低（p<0.05）。有趣的是，第2组的Ca×P乘积（≥55mg/dL）显著高于第1组（p<0.05）。HOMA-IR与人体测量、血液透析充分性、血浆PTH水平、心脏参数和炎症标志物之间无显著相关性。我们在HD患者队列中确定IR的患病率为31.6%。
低HOMA-IR值与目标hct水平和rHuEpo的使用之间存在正相关。由于胰岛素抵抗是ESRD患者心血管死亡的独立危险因素，因此认为能够纠正胰岛素抵抗可能是该队列中的一种新的治疗方法。
