Satirapoj Bancha, Supasyndh Ouppatham, Phantana-Angkul Panipat, Ruangkanchanasetr Prajej, Nata Naowanit, Chaiprasert Amnart, Kanjanakul Inseey, Choovichian Panbuppa
Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
J Med Assoc Thai. 2011 Sep;94 Suppl 4:S87-93.
Insulin resistance is frequently recognized in uremic patients and is a predictor of cardiovascular mortality in end stage renal disease (ESRD) patients. However sparse data are available regarding the effects of different methods of renal dialysis on insulin resistance in ESRD without diabetes. The present study was conducted to evaluate the levels of insulin resistance in dialysis versus non dialysis ESRD patients without diabetes.
A cross-sectional study was carried out in 45 non diabetic ESRD patients including continuous ambulatory peritoneal dialysis (CAPD), hemodialysis (HD), and non dialysis ESRD patients. The value of insulin resistance was obtained by homeostasis model assessment (HOMA). Estimation of the glomerular filtration rate (GFR) was obtained by the four-variable Modification of Diet in Renal Disease equation and ESRD was defined when GFR was below 15 ml/min/1.73 m2.
Non diabetic ESRD patients were studied: 12 patients on CAPD treatment for 67.4 months, 18 patients on HD treatment for 89.3 months, and 15 patients on conservative treatment. HOMA scores (CAPD 5.4 +/- 2.3, HD 6.0 +/- 1.9 vs. non dialysis 1.5 +/- 0.9, p < 0.05) and fasting plasma insulin levels (CAPD 21.9 +/- 7.7 microU/mL, HD 19.5 +/- 8.4 microU/mL vs. non dialysis 4.4 +/- 2.5 microU/mL, p < 0.05) of the CAPD and HD groups were significantly higher than the non dialysis ESRD group, with no significant differences observed between CAPD and HD groups. However, fasting plasma glucose was significantly lower in the HD group than the CAPD and non dialysis ESRD groups (CAPD 98.2 +/- 10.6 mg/dL, non dialysis 93.0 +/- 11.5 mg/dL vs. HD 76.2 +/- 7.8 mg/dL, p < 0.05). All groups showed no significant differences for blood pressure, body weight, body mass index, fat free mass, body fat, and serum levels of albumin, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides.
Impaired insulin sensitivity in both dialysis groups after long term dialysis was still higher than that of the non dialysis ESRD group. However, no significant differences were noted between CAPD and HD treatments.
胰岛素抵抗在尿毒症患者中较为常见，是终末期肾病（ESRD）患者心血管死亡的预测指标。然而，关于不同肾脏透析方法对非糖尿病ESRD患者胰岛素抵抗影响的数据却很少。本研究旨在评估非糖尿病透析与非透析ESRD患者的胰岛素抵抗水平。
对45例非糖尿病ESRD患者进行了一项横断面研究，包括持续性非卧床腹膜透析（CAPD）、血液透析（HD）和非透析ESRD患者。胰岛素抵抗值通过稳态模型评估（HOMA）获得。肾小球滤过率（GFR）通过四变量肾病饮食改良方程估算，当GFR低于15 ml/min/1.73 m2时定义为ESRD。
对非糖尿病ESRD患者进行了研究：12例接受CAPD治疗67.4个月，18例接受HD治疗89.3个月，15例接受保守治疗。CAPD组和HD组的HOMA评分（CAPD 5.4±2.3，HD 6.0±1.9 vs.非透析组1.5±0.9，p<0.05）和空腹血浆胰岛素水平（CAPD 21.9±7.7 microU/mL，HD 19.5±8.4 microU/mL vs.非透析组4.4±2.5 microU/mL，p<0.05）显著高于非透析ESRD组，CAPD组和HD组之间未观察到显著差异。然而，HD组的空腹血糖显著低于CAPD组和非透析ESRD组（CAPD 98.2±10.6 mg/dL，非透析组93.0±11.5 mg/dL vs. HD 76.2±7.8 mg/dL，p<0.05）。所有组在血压、体重、体重指数、去脂体重、体脂以及白蛋白、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯的血清水平方面均无显著差异。
长期透析后，两个透析组的胰岛素敏感性受损程度仍高于非透析ESRD组。然而，CAPD和HD治疗之间未观察到显著差异。
