Download PDF
Horm Metab Res 2004; 36(10): 716-720
DOI: 10.1055/s-2004-826021
Original Clinical
© Georg Thieme Verlag KG Stuttgart · New York

The Comparison of Insulin Sensitivity in Non-diabetic Hemodialysis Patients Treated with and without Recombinant Human Erythropoietin

A.  Tuzcu1 , M.  Bahceci1 , E.  Yilmaz2 , S.  Bahceci3 , S.  Tuzcu4
  • 1Departments of Endocrinology and Metabolism, University of Dicle School of Medicine, Diyarbakir, Turkey
  • 2Department of Nephrology, University of Dicle School of Medicine, Diyarbakir, Turkey
  • 3Department of Histology and Embryology, University of Dicle School of Medicine, Diyarbakir, Turkey
  • 4Department of Nuclear Medicine. University of Dicle School of Medicine, Diyarbakir, Turkey
Further Information

Publication History

Received 12 January 2004

Accepted after revision 31 March 2004

Publication Date:
03 November 2004 (online)

Also available at
    Permissions and Reprints

Abstract

Background: Patients with end-stage renal disease (ESRD) are known to have insulin resistance. Treatment with EPO is associated with improvement in insulin sensitivity in uremic patients. The aim of this study was to compare insulin sensitivity and pancreatic B cell function in adult non-diabetic uremic hemodialysis patients treated with or without rHuEPO. Subjects and Methods: Three groups of subjects were included to the study: hemodialysis patients treated with rHuEPO [EPO(+) group] or without rHuEPO [EPO(-) group], and healthy controls. Anthropometrical parameters, lipid levels, fasting glucose and insulin levels were measured in all subjects. Homeostasis Model Assessment (HOMA) was used to compare insulin sensitivity. ANOVA, independent t-test, and Pearson correlation were used for statistical analysis. Results: Mean insulin level of control group (20.04 ± 7.2 pmol/l) was significantly lower than EPO(+) group (p < 0.04) and EPO(-) group (p < 0.0001). HOMA-(%B) levels in the EPO(+) group were significantly lower than in the EPO(-) group (106 ± 42, 140 ± 63 respectively, p < 0.02). HOMA-(%B) levels in the control group (66 ± 17) were significantly lower than in the EPO(+) and EPO(-) group (p < 0.005 and p < 0.0001 respectively). HOMA-(%S) levels in the EPO(+) groups was significantly higher than in the EPO(-) group (91 ± 40, 56 ± 26, respectively; p < 0.01). HOMA-(%S) levels of control group (125 ± 24) was significantly higher than EPO(+) and EPO(-) groups (p < 0.02, p < 0.0001 respectively). We found a positive correlation between duration of erythropoietin treatment and insulin sensitivity (r = 0.484, p < 0.002). Conclusions: Firstly, patients treated with EPO are insulin sensitive compared to patients not treated with EPO. Secondly, duration of erythropoietin treatment is positively correlated with insulin sensitivity in hemodialysis patients.

Key words

EPO - Hemodialysis - HOMA-(%B) - HOMA-(%S) - Insulin - Uremia

References

  • 1 Shinohara K, Shoji T, Emoto M, Tahara H, Koyama H, Ishimura E, Miki T, Tabata T, Nishizawa Y. Insulin resistance as an independent predictor of cardiovascular mortality inpatients with end-stage renal disease.  J Am Soc Nephrol. 2002;  13 1894-1900
    CrossrefPubMedSearch in Google Scholar
  • 2 Hager S R. Insulin resistance of uremia.  Am J Kidney Dis. 1989;  14 272-276
    PubMedSearch in Google Scholar
  • 3 Spaia S, Pangalos M, Askepidis N, Pazarloglou M, Mavropoulou E, Theodoridis S, Dimitrakopoulos K, Milionis A, Vayonas G. Effect of short-term rHuEPO treatment on insulin resistance in hemodialysis patients.  Nephron. 2000;  84 320-325
    CrossrefPubMedSearch in Google Scholar
  • 4 Rasic-Milutinovic Z, Perunicic-Pekovic G, Pljesa S. Clinical significance and pathogenic mechanisms of insulin resistance in chronic renal insufficiency (part II): pathogenic factors of insulin resistance in chronic renal insufficiency.  Med Pregl. 2000;  53 159-163
    PubMedSearch in Google Scholar
  • 5 Oshida Y, Sato Y, Shiraishi S, Sakamoto N. Studies on glucose intolerance in chronic renal failure: Estimation of insulin sensitivity before and after initiation of hemodialysis.  Clin Nephrol. 1987;  28 35-38
    PubMedSearch in Google Scholar
  • 6 Matthews D R, Hosker J P, Rudenski A S, Burnett M A, Darling P. et al . Homeostasis model assessment: insulin resitance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
    Search in Google Scholar
  • 7 Perez-Martin A, Raynaud E, Hentgen C, Bringer J, Mercier J, Brun J F. Simplified measurement of insulin sensitivity with the minimal model procedure in type 2 diabetic patients without measurement of insulinemia.  Horm Metab Res. 2002;  34 102-106
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Mak R H. 1,25 dihydroxycholecalciferol corrects glucose intolerance in hemodialysis patients.  Kidney Int. 1992;  41 1048-1054
    PubMedSearch in Google Scholar
  • 9 Borissova A M, Djambazova A, Todorov K, Dakovska L, Tankova T, Kirilov G. Effect of erythropoietin on the metabolic state and peripheral insulin sensitivity in diabetic patients on hemodialysis.  Nephrol Dial Transplant. 1993;  8 93-95
    PubMedSearch in Google Scholar
  • 10 Chagnac A, Korzets A, Zevin D, Korzets A, Hirsh J, Gafter U, Levi J. Effect of erythropoietin on glucose tolerance in hemodialysis patients.  Clin Nephrol. 1994;  42 398-400
    PubMedSearch in Google Scholar
  • 11 Mak R H. Metabolic effects of erythropoietin in patients on peritoneal dialysis.  Pediatr Nephrol. 1998;  12 660-665
    CrossrefPubMedSearch in Google Scholar
  • 12 Stefanovic V, Nesic V, Stojimirovic B. Treatment of insulin resistance in uremia.  Int J Artif Organs. 2003;  26 100-104
    PubMedSearch in Google Scholar
  • 13 NKF K/DOQI Clinical practice guidelines 2000 The National Kidney Foundation. www.kidney.org/professionals/doqi/guidelines. 
  • 14 Shoji T, Emoto M, Nishizawa Y. HOMA index to assess insulin resistance in renal failure patients.  Nephron. 2001;  89 348-349
    CrossrefPubMedSearch in Google Scholar
  • 15 Beck-Nielsen H. Insulin resistance: Organ manifestations and cellular mechanisms.  Ugeskr Laeger. 2002;  164 2130-2135
    PubMedSearch in Google Scholar
  • 16 Mak R H. Effect of recombinant human erythropoietin on insulin, amino acid, and lipid metabolism in uremia.  J Pediatr. 1996;  129 97-104
    PubMedSearch in Google Scholar
  • 17 Wu Z, Bao X. Effects of benazepril on insulin resistance and glucose tolerance in uremia.  Clin Nephrol. 1998;  50 108-112
    PubMedSearch in Google Scholar
  • 18 Eschback J W, Kelly M R, Haley N R, Abels I, Adamson J W. Correction of anemia in progressive renal failure with recombinant human erythropoietin.  N Engl J Med. 1989;  321 158-163
    CrossrefPubMedSearch in Google Scholar
  • 19 Barrany P, Peterson E, Ahberg M, Hultman E, Bergstrom J. Nutritional assessment in anemic hemodialysis patients treated with human recombinant erythropoietin.  Clin Nephrol. 1991;  35 270-279
    PubMedSearch in Google Scholar
  • 20 Mak R H, Turner C, Haycock G B, Chantler C. Secondary hyperthyroidism and glucose intolerance in children with uremia.  Kidney Int. 1983;  16 (Suppl 24) 122
    PubMedSearch in Google Scholar

A. Tuzcu

Dicle Universitesi · Tip Fakultesi · Endokrinoloji BD. 21 280

Diyarbakir · Turkey ·

Phone: +90(412)248-80-01

Fax: +90(412)248-85-20

Email: atuzcu@dicle.edu.tr