Insulin Resistance in Dialysis versus Non Dialysis End Stage Renal Disease Patients without Diabetes
Bancha Satirapoj MD*, Ouppatham Supasyndh MD*, Panipat Phantana-Angkul BSc, MPH*, Prajej Ruangkanchanasetr MD*, Naowanit Nata MD*, Amnart Chaiprasert MD*, Inseey Kanjanakul MD*, Panbuppa Choovichian MD*
Affiliation : *Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Objective : 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.
Material and Method: 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.
Results : 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 μU/mL, HD 19.5 + 8.4 μU/mL vs. non
dialysis 4.4 + 2.5 μU/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.
Conclusion : 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.
Keywords : Insulin resistance, Hyperinsulinemia, End stage renal disease, Hemodialysis, Peritoneal dialysis
