Glucose intolerance in children with chronic renal failure.

Carbohydrate metabolism was studied by the hyperglycemic clamp technique in 14 children with moderate to severe chronic renal failure (CRF) (8 pubertal and 6 prepubertal) and was compared with 5 healthy prepubertal children and 7 healthy young adults. Constant hyperglycemia was maintained for 120 min. Under these conditions, the average glucose infusion rate (M) is an index of glucose metabolic rate, the average insulin response (I) is an index of beta cell responsiveness to hyperglycemia, and the M/I ratio is an index of insulin sensitivity. Children with CRF were glucose intolerant (lower M), hyperinsulinemic (higher I), and insulin resistant (lower M/I) compared with the control children. An age-related difference in glucose tolerance and insulin sensitivity was noted. Pubertal children with CRF had lower M and lower M/I compared with prepubertal children with CRF. The 7 adult controls also had lower M and lower M/I compared with the 5 children controls. M and M/I correlated with glomerular filtration rate (GFR) in the 8 pubertal children, while M/I also correlated with GFR in the 6 prepubertal children with CRF. The hyperglycemic clamp provides a useful tool in studying the pathogenesis of carbohydrate disturbances in children with CRF.