The determination of insulin sensitivity in hemodialysis and continuous ambulatory peritoneal dialysis in nondiabetic patients with end-stage renal disease.
The determination of insulin sensitivity in hemodialysis and continuous ambulatory peritoneal dialysis in nondiabetic patients with end-stage renal disease.
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发表时间：
2005-05
影响因子：
1.6
通讯作者：
A. Tuzcu;M. Bahçeci;M. Yılmaz;C. Turgut;I. Kara
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作者：
A. Tuzcu;M. Bahçeci;M. Yılmaz;C. Turgut;I. Kara
目的应用稳态模型（HOMA）和曲线下面积（AUC）评价非糖尿病尿毒症血液透析（HD）和持续性非卧床腹膜透析（CAPD）患者胰岛β细胞功能和胰岛素敏感性。方法研究于2001年1月至8月在土耳其迪亚巴基尔Dicle大学医学院肾脏科进行。51例HD患者、45例CAPD患者和50例健康对照受试者入组研究。测量身高、体重、腰围和臀围、脂肪量和体脂百分比以及体重指数（BMI）。测定总高密度脂蛋白（HDL）和低密度脂蛋白（LDL）-胆固醇、甘油三酯、尿素、肌酐、胰岛素、钾、甲状旁腺激素（PTH）和1，25二羟胆钙化醇水平。血液透析组患者在透析周中期进行口服葡萄糖耐量试验（OGTT），而持续性不卧床腹膜透析组患者至少在一夜未透析后进行OGTT。计算胰岛素和葡萄糖的曲线下面积。HOMA [胰岛素敏感性（%S）]和AUC用作组织胰岛素敏感性的指标。结果CAPD患者的LDL-胆固醇水平明显高于HD组（P<0.001）和对照组（P<0.0001）。两组的基线血糖水平无显著差异。CAPD组基线胰岛素水平高于HD组（p<0.001）和对照组（p<0.0001）。CAPD组血糖曲线下面积（AUCgluc）和胰岛素曲线下面积（AUCins）均高于HD组和对照组（p<0.0001）。CAPD组的HOMA [β细胞功能（%B）]值高于HD组（p<0.02）和对照组（p<0.04）。CAPD组HOMA [胰岛素敏感性（%S）]水平显著低于HD组（p<0.002）和对照组（p<0.001）。结论CAPD治疗可导致非糖尿病终末期肾病患者胰岛素不敏感，CAPD溶液中葡萄糖含量过高可能是CAPD患者胰岛素抵抗的原因。
OBJECTIVE To determine the beta-cell function and insulin sensitivity with homeostasis model assessment (HOMA) and area under curve (AUC) in nondiabetic uremic hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients cross sectionally. METHODS The study was performed between January to August 2001 in the Department of Nephrology, Dicle University School of Medicine, Diyarbakir, Turkey. Fifty-one HD patients, 45 CAPD patients, and 50 healthy control subjects were included in the study. Height, weight, waist and hip circumference, fat mass and percentage of body fat, and body mass index (BMI) were measured. The total high density lipoprotein (HDL) and low density lipoprotein (LDL)-cholesterol, triglyceride, urea, creatinine, insulin, potassium, parathyroid hormone (PTH) and 1,25 dihydroxycholecalciferol levels were measured. Oral glucose tolerance test (OGTT) was performed in the mid-week dialysis-free interval in HD patients, whereas after at least a night without dialysis exchanges in CAPD group. Area under curve both of insulin and glucose were calculated. The HOMA [insulin sensitivity (%S)] and AUC were used as indices of tissue insulin sensitivity. RESULTS The LDL-cholesterol levels of patients with CAPD was higher than the HD group (p<0.001) and control group (p<0.0001). The baseline glucose levels of the 2 groups were not significantly different. Baseline insulin levels of CAPD group were higher than the HD group (p<0.001) and the control group (p<0.0001). Area under curve for glucose (AUCgluc) and insulin (AUCins) value of CAPD patients were higher than the HD patients than the control group (p<0.0001). The HOMA [beta-cell function (%B)] values of CAPD group were higher than both HD (p<0.02) and control group (p<0.04). The HOMA [insulin sensitivity (%S)] levels of CAPD group was significantly lower than the HD patients (p<0.002) and the control group (p<0.001). CONCLUSION The CAPD treatment may lead to insulin insensitivity in non-diabetic end-stage renal disease patients and the high glucose content of CAPD solutions may be responsible for insulin resistance in CAPD patients.