The comprasion of insülin sensitivity and panereatic beta cell function in hemodialysis and patients with end-stage renal disease

ABSTRACT BACKGROUND: to compare the effects of HD and CAPD on beta-cell function (%B) and insulin sensitivity (%S) in adult non-diabetic uraemic patients by using the Homeostasis Model Assessment (HOMA). SUBJECTS AND METHODS : Fifty-one HD patients 45 CAPD patients, and 50 healthy control subjects were included to the study. All of the patients height, weight and waist and hip circumference, fat mass, fat percent were measured and body mass index was calculated. Total-cholesterol, HDL-cholesterol, LDL- cholesterol, triglyceride, urea, creatinine, insulin, potassium, parathyroid hormone and 1,25 dihydroxycholecalciferol levels were measured. Glucose levels were measured before and at the 120th minute after initiation of dialysis modality. Homeostasis Model Assessment (HOMA) was used indices of pancreatic beta cell function [HOMA-(%B)] and tissue insulin sensitivity [HOMA-(%S). RESULTS: LDL-cholesterol levels of patients with CAPD was higher than hemodialysis group and control group (p<0.001 and p< 0.0001 respectively). Pre- dialysis glucose levels of two groups were not found significantly different. But at 120th minute mean glucose level in CAPD patients was higher than HD patients (p<0.007). Insulin levels of CAPD group were higher than HD group and control group (pO.001, p< 0.0001 respectively). HOMA- (%B) values of CAPD group were higher than both HD and conjrol group (p<0.02, p<0.04 respectively). HOMA-(%S) levels of CAPD group was significantly lower than HD and control group ( p<0.002, p<0.001 respectively). CONCLUSIONS: 1- CAPD treatment may lead to insulin insensitivity in non- diabetic ESRD patients. 2-High glucose content of CAPD solutions and, therefore glucotoxicity, may be responsible from this insulin resistance in CAPD patients. Key words: HOMA-(%S), HOMA-(%B), insulin, uremia, hemodialysis, CAPD, acidosis, PTH. 59