Servicio de Nefrología. Hospital Universitario La Paz. Madrid, Spain.
Nefrologia. 2013 Jan 18;33(1):85-92. doi: 10.3265/Nefrologia.pre2012.Nov.11430.
Terminal chronic renal failure patients show early insulin resistance (IR), characterised by alterations in the hydrocarbon metabolism and hyperinsulinaemia generally associated with dyslipidaemia and a proinflammatory condition. Cardiovascular disease (CVD) is the main cause of mortality in patients on dialysis. There is a strong association between IR, hyperinsulinism and CV disease. The objective of this study was to evaluate the effect of peritoneal dialysis (PD) on IR and its effects on the subsequent CVD morbidity and mortality in nondiabetic uraemic patients. It involved 69 nondiabetic patients on PD, 35 incident patients (≤ 3 months on PD) and 34 prevalent patients (>3 months on PD), with 2 estimated insulin resistance measurements 12 months apart using the insulin resistance index (HOMAIR). The mean HOMAIR value in incident patients was 1.8 ± 1.3 and 2.2 ± 2.1 at baseline situation and at 12 months respectively (not significant [NS]). In prevalent patients these values were 2.3 ± 1.3 and 2.5 ± 2.2 (NS). In our study, the mean glucose, insulin and IR concentrations measured by the HOMAIR and QUICKI indexes (the latter being a quantitative control for insulin sensitivity control) were similar at baseline situation and the following year, in both incident and prevalent patients. We did not find any significant differences in relation to CVD comorbidity, ischaemic heart disease, heart failure or cerebrovascular or peripheral comorbidity neither in the HOMAIR index or insulin levels. To conclude, nondiabetic patients on PD do not display a significant increase in HOMAIR levels and this remains the case over time when on dialysis. This, in turn, suggests that PD is not an IR risk factor. The fact that the IR indexes are not associated with CVD morbidity or mortality seems to suggest that this is a less significant factor in the field of PD.
终末期慢性肾衰竭患者表现出早期胰岛素抵抗（IR），其特征为碳氢化合物代谢改变和高胰岛素血症，通常与血脂异常和促炎状态相关。心血管疾病（CVD）是透析患者死亡的主要原因。IR、高胰岛素血症和 CV 疾病之间存在很强的相关性。本研究旨在评估腹膜透析（PD）对 IR 的影响及其对非糖尿病尿毒症患者随后 CVD 发病率和死亡率的影响。该研究纳入了 69 名接受 PD 治疗的非糖尿病患者，其中 35 名新发病例（PD 治疗≤3 个月）和 34 名现患病例（PD 治疗>3 个月），在 12 个月的时间里使用胰岛素抵抗指数（HOMAIR）对 2 次胰岛素抵抗进行了估计。新发病例的平均 HOMAIR 值在基线时为 1.8±1.3，在 12 个月时为 2.2±2.1（无显著差异[NS]）。在现患病例中，这些值分别为 2.3±1.3 和 2.5±2.2（NS）。在我们的研究中，通过 HOMAIR 和 QUICKI 指数（后者是胰岛素敏感性控制的定量指标）测量的葡萄糖、胰岛素和 IR 浓度在基线和次年在新发病例和现患病例中均相似。我们未发现 CVD 合并症、缺血性心脏病、心力衰竭或脑血管或周围血管合并症与 HOMAIR 指数或胰岛素水平之间存在任何显著差异。总之，接受 PD 治疗的非糖尿病患者的 HOMAIR 水平没有明显升高，并且在透析期间随时间推移仍然如此。这反过来表明 PD 不是 IR 的危险因素。IR 指数与 CVD 发病率或死亡率无关这一事实表明，在 PD 领域，这是一个不太重要的因素。
