Anti‐inflammatory effect of an insulin infusion in patients on maintenance haemodialysis: A randomized controlled pilot study

Vos, Frederiek E.; Manning, Patrick J.; Sutherland, W. H. F.; Schollum, John; Walker, Robert

doi:10.1111/j.1440-1797.2010.01329.x

Cited by 6 publications

(6 citation statements)

References 48 publications

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“…Previous reports on changes in CRP levels during HD are inconsistent as some studies show an increase [32,51,52] and others no change [6,16,53]. The concentrations of IL-6 and TNF-α were unchanged in our study, whereas IL-1β concentrations fell.…”

Section: Discussioncontrasting

confidence: 77%

“…In comparison, a recent cross-over study showed that compared with a 4-h HD session conducted during fasting but preceded by a breakfast meal, the addition of low-dose insulin infusion (Actrapid 2 IU/h) during HD resulted in a reduction in plasma CRP, whereas IL-6 and TNF-α levels were unaffected [32]. …”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, insulin appears to exert anti-inflammatory effects [31,32]. Therefore, we hypothesized that maintenance of hyperinsulinemia during HD by either glucose or glucose-insulin infusion would suppress the HD-induced decrease in serum bioactive IGF-I as well as the increase in plasma IL-6.…”

Section: Introductionmentioning

confidence: 99%

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Effect of hyperinsulinemia during hemodialysis on the insulin-like growth factor system and inflammatory biomarkers: a randomized open-label crossover study

et al. 2013

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BackgroundA marked reduction in serum levels of bioactive insulin-like growth factor-I (IGF-I) has been observed in fasting hemodialysis (HD) patients during a 4-h HD session. The aim of the present study was to investigate the beneficial effect of hyperinsulinemia during HD on bioactive IGF-I and inflammatory biomarkers.MethodsIn a randomized cross-over study, 11 non-diabetic HD patients received a standardised HD session with either: 1) no treatment, 2) glucose infusion (10% glucose, 2.5 mL/kg/h), or 3) glucose-insulin infusion (10% glucose added 30 IU NovoRapid® per litre, 2.5 mL/kg/h). Each experiment consisted of three periods: pre-HD (−120 to 0 min), HD (0 to 240 min), and post-HD (240 to 360 min). A meal was served at baseline (−120 min); infusions were administered from baseline to 240 min. The primary outcome was change in bioactive IGF-I during the experiment. Secondary outcomes were changes in high-sensitivity C-reactive protein, interleukin-1β, interleukin-6, and tumor necrosis factor α. Comparisons were performed using mixed-model analysis of variance for repeated measures.ResultsFrom baseline to the end of study, no significant differences were observed in the changes in either serum bioactive IGF-I or total IGF-I between study days. Overall, serum bioactive IGF-I levels rose above baseline at 120 to 300 min with a maximum increase of 20% at 120 min (95% confidence interval (CI), 9 to 31%; p < 0.001), whereas total IGF-I levels rose above baseline at 180 to 300 min with a maximum increase of 5% at 240 min (95% CI, 2 to 9%; p = 0.004). A significant difference was observed in the changes in serum IGF-binding protein-1 (IGFBP-1) between study days (p = 0.008), but differences were only significant in the post-HD period. From baseline to the end of HD, no significant difference was observed in the changes in serum IGFBP-1 levels between study days, and in this time period overall serum IGFBP-1 levels were below baseline at all time points with a maximum decrease of 51% at 180 min (95% CI, 45 to 57%; p < 0.001). None of the investigated inflammatory biomarkers showed any differences in the changes over time between study days.ConclusionsPostprandial insulin secretion stimulated the IGF-system during HD with no further effect of adding glucose or glucose-insulin infusion. Hyperinsulinemia during HD had no effect on biomarkers of inflammation.Trial registrationClinicalTrials.gov registry: NCT01209403

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Effect of hyperinsulinemia during hemodialysis on the insulin-like growth factor system and inflammatory biomarkers: a randomized open-label crossover study

et al. 2013

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“…IR in patients on maintenance HD was ameliorated after 12 weeks of treatment with angiotensin II receptor blockers [131]. However, insulin per se may have a modest anti-inflammatory effect as evidenced by a reduction in serum CRP that appears to have a persistent effect over the 24 h after dialysis [132]. …”

Section: Treatment Of Ir In Ckdmentioning

confidence: 99%

Insulin Resistance in Patients with Chronic Kidney Disease

Liao

Sung

Hung

et al. 2012

Journal of Biomedicine and Biotechnology

124

117

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Metabolic syndrome and its components are associated with chronic kidney disease (CKD) development. Insulin resistance (IR) plays a central role in the metabolic syndrome and is associated with increased risk for CKD in nondiabetic patients. IR is common in patients with mild-to-moderate stage CKD, even when the glomerular filtration rate is within the normal range. IR, along with oxidative stress and inflammation, also promotes kidney disease. In patients with end stage renal disease, IR is an independent predictor of cardiovascular disease and is linked to protein energy wasting and malnutrition. Systemic inflammation, oxidative stress, elevated serum adipokines and fetuin-A, metabolic acidosis, vitamin D deficiency, depressed serum erythropoietin, endoplasmic reticulum stress, and suppressors of cytokine signaling all cause IR by suppressing insulin receptor-PI3K-Akt pathways in CKD. In addition to adequate renal replacement therapy and correction of uremia-associated factors, thiazolidinedione, ghrelin, protein restriction, and keto-acid supplementation are therapeutic options. Weight control, reduced daily prednisolone dosage, and the use of cyclosporin decrease the risk of developing new-onset diabetes after kidney transplantation. Improved understanding of the pathogenic mechanisms underlying IR in CKD may lead to more effective therapeutic strategies to reduce uremia-associated morbidity and mortality.

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“…Other adverse effects of hyperglycemia are its associated cardiovascular risks [24][25][26] and pro-thrombotic [27,28] and pro-inflammatory effects [29,30]. It may be noted at this point that other studies have shown anti-inflammatory effects of insulin infu-sions in hospital settings [31,32] and during the course of HD treatments [33]. However, this requires additional research and had not been a subject of this investigation.…”

Section: Discussionmentioning

confidence: 93%

Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial

Raimann

Kruse

Thijssen

et al. 2011

Nephrology Dialysis Transplantation

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Anti‐inflammatory effect of an insulin infusion in patients on maintenance haemodialysis: A randomized controlled pilot study

Cited by 6 publications

References 48 publications

Effect of hyperinsulinemia during hemodialysis on the insulin-like growth factor system and inflammatory biomarkers: a randomized open-label crossover study

Effect of hyperinsulinemia during hemodialysis on the insulin-like growth factor system and inflammatory biomarkers: a randomized open-label crossover study

Insulin Resistance in Patients with Chronic Kidney Disease

Metabolic effects of dialyzate glucose in chronic hemodialysis: results from a prospective, randomized crossover trial

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