The relationship of insulin resistance in chronic hemodialysis patients with the inflamatory indicators (hs-CRP, IL-6, TNF- alpha, Leptin, Adiponectin),the malnutrition and echocardiographic parameters and 24 hour ambulatory blood pressure monitoring

The relationship between malnutrition, echocardiographic parameters,24 hours ambulatory blood pressure (ABP) parameters and deccreasedinsulin sensitivity (ISI-S) in chronic hemodialysis (HD) patients wasinvestigated.The measurements ISI-S and inflamatory indicators were performed.The nutritional state was assessed by malnutrition score. Theechocardiography (ECHO) and 24 hours ABP were performed.The ISI-S had inverse correlations with nighttime mean BP /daytimemean BP ratio (p= 0.021), malnutrition score (p< 0.01). Hs-CRP, nighttimemean BP /daytime mean BP and vena cava collapse index wereindependent risk factors affecting ISI-S (p< 0.001; ß=0.412, p=0.025; ß=-0.204, p< 0.001; ß=-0.465).The decrease in ISI-S along with the hypervolemia suggests thatvolume overload is a contributing factor in the pathogenesis of IR inchronic renal failure patients. This study tempt us to think that, in additionto the traditional cardiovascular risk factors in CRF patients, IR can beregarded as a risk factor but not an independent one, mainly a reflection ofthe underlying culprit, hypervolemia.