Studies on glucose intolerance in chronic renal failure: estimation of insulin sensitivity before and after initiation of hemodialysis.

Using the euglycemic insulin clamp technique, we quantified insulin resistance in the genesis of the glucose intolerance observed in patients with CRF. Tissue sensitivity to insulin was evaluated in 11 patients with CRF (just before, and at one and four weeks after initiation of hemodialysis). The glucose infusion rate in patients with CRF (4.38 +/- 0.28 mg/kg/min) was significantly lower than in 28 controls (7.40 +/- 0.21 mg/kg/min) (p less than 0.001). The decreased glucose infusion rate in patients with CRF increased to 5.63 +/- 0.44 mg/kg/min (p less than 0.02) one week after starting hemodialysis and further improved to 7.46 +/- 0.90 mg/kg/min (p less than 0.02) after four weeks of hemodialysis. During the insulin clamp study, free fatty acid (FFA) decreased more rapidly in patients with CRF (both before and after initiation of hemodialysis) than in the controls (p less than 0.05-0.001). Glycerol decreased gradually in both groups, showing only a 50-60% reduction in 120 min. These results confirm that glucose intolerance in patients with CRF can be improved by the initiation of hemodialysis.