Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality
Repeated analysis of estimated insulin resistance using the HOMAIR index in nondiabetic patients on peritoneal dialysis and its relationship with cardiovascular disease and mortality
复制标题
DOI：
10.3265/nefrologia.pre2012.nov.11430
复制
发表时间：
2013-01-01
期刊：
影响因子：
--
通讯作者：
Bajo, M. Auxiliadora
中科院分区：
文献类型：
--
作者：
Sánchez-Villanueva, Rafael;Estrada, Patricia;Bajo, M. Auxiliadora
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和高胰岛素血症的改变，通常与血脂异常和促炎性疾病相关。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疾病之间存在强相关性。本研究的目的是评估腹膜透析（PD）对非糖尿病尿毒症患者IR的影响及其对随后CVD发病率和死亡率的影响。研究涉及69例接受PD治疗的非糖尿病患者，35例事件患者（接受PD治疗3个月），使用胰岛素抵抗指数（HOMAIR）进行2次估计胰岛素抵抗测量，间隔12个月。在基线情况和12个月时，事件患者的平均HOMAIR值分别为1.8 +/- 1.3和2.2 +/- 2.1（无显著性[NZ]）。在普遍患者中，这些值分别为2.3 +/- 1.3和2.5 +/- 2.2（NS）。在我们的研究中，平均血糖，胰岛素和IR浓度测量HOMAIR和QUICKI指数（后者是胰岛素敏感性控制的定量控制）是相似的，在基线情况下和下一年，在事件和流行的患者。我们没有发现任何显着差异，CVD合并症，缺血性心脏病，心力衰竭或脑血管或外周合并症，无论是在HOMAIR指数或胰岛素水平。综上所述，非糖尿病PD患者的HOMAIR水平未显示显著升高，并且在透析期间随着时间的推移仍然如此。
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), 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 [NZ]) 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 cerebro vascular 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.