Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Center for Diabetes Research, Department of Medicine, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark The NNF Center for Basic Metabolic Research, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Nephrol Dial Transplant. 2015 Mar;30(3):513-20. doi: 10.1093/ndt/gfu327. Epub 2014 Oct 15.
Patients with end-stage renal disease (ESRD) have increased fasting concentrations and disturbed postprandial responses of several glucoregulatory hormones. We aimed to evaluate the impact of high-flux haemodialysis (HD) and high-volume haemodiafiltration (HDF) on fasting and postprandial plasma levels of glucoregulatory pancreatic and gut peptide hormones in ESRD patients.
Ten non-diabetic HD-treated ESRD patients were included to undergo a 3-h standardized liquid mixed meal test 1 h into an HD and an HDF, respectively. On a third, optional, examination day, the meal test was performed without concurrent dialysis treatment. Concentrations of glucose, C-peptide, insulin, glucagon, glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide were measured in plasma and dialysate.
Ten participants completed the meal test during HD, eight completed the meal test during HDF and four completed the optional meal test without dialysis. All plasma hormone concentrations declined significantly during the first fasting hour of dialysis with no differences between HD and HDF. Significant clearance of the investigated hormones was observed for both dialysis modalities with significantly higher clearance of insulin, C-peptide and GIP during HDF compared with HD. The fractional appearance of hormones entering the utilized dialysate was higher during HDF. Both dialysis modalities reduced postprandial plasma hormone concentrations in a similar manner.
Our findings show that HD and HDF, respectively, significantly remove glucoregulatory peptide hormones from plasma of non-diabetic ESRD patients; a phenomenon which may affect the glucose metabolism in dialysis-treated ESRD patients.
终末期肾病（ESRD）患者空腹时多种糖调节激素浓度升高，且餐后激素反应紊乱。我们旨在评估高通量血液透析（HD）和高容量血液透析滤过（HDF）对 ESRD 患者空腹和餐后糖调节胰腺和肠道肽激素的血浆水平的影响。
纳入 10 名非糖尿病的 HD 治疗 ESRD 患者，分别在 HD 和 HDF 治疗 1 小时后进行 3 小时标准化液体混合餐测试。在第 3 天的可选检查日，不进行透析治疗的情况下进行餐测。测量血浆和透析液中的葡萄糖、C 肽、胰岛素、胰高血糖素、胰高血糖素样肽-1 和葡萄糖依赖性胰岛素释放肽的浓度。
10 名参与者在 HD 期间完成了餐测，8 名参与者在 HDF 期间完成了餐测，4 名参与者在无透析的情况下完成了可选的餐测。所有血浆激素浓度在透析的第一个空腹小时内均显著下降，HD 和 HDF 之间无差异。两种透析方式均观察到研究激素的明显清除，与 HD 相比，HDF 时胰岛素、C 肽和 GIP 的清除率明显更高。进入所使用透析液的激素出现分数更高。两种透析方式均以相似的方式降低餐后血浆激素浓度。
我们的研究结果表明，HD 和 HDF 分别从非糖尿病 ESRD 患者的血浆中显著清除糖调节肽激素；这一现象可能会影响透析治疗的 ESRD 患者的葡萄糖代谢。
