Is There a Role for Intensive Insulin Therapy in Patients With Kidney Disease?

Ritchie-McLean, Susanna; Kirwan, Chris; Levy, Jeremy

doi:10.1053/j.ajkd.2007.05.011

Cited by 6 publications

(4 citation statements)

References 41 publications

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“…Until recently the main interest in glucose during hemodialysis has been to prevent hemodialysis-induced hypoglycemia and the loss of calories when using glucose-free dialysate [1][2][3]. Meanwhile, there is growing concern regarding uncontrolled hyperglycemia [4]. Furthermore, impaired glucose control is considered to play a major role in the high morbidity and mortality of hemodialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

Niemczyk

Schneditz

Wojtecka

et al. 2021

Diabetes Research and Clinical Practice

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The disposal of a glucose bolus was studied to identify glucose metabolism in patients with and without type 2 diabetes mellitus (T2DM) during their regular hemodialysis (HD) treatment. Methods: Plasma glucose, insulin, and c-peptide concentrations were measured during a 60 min observation phase following a rapid glucose infusion (0.5 g/kg dry weight). Glucose disposition and elimination rates were determined from kinetic analysis, and insulinogenic index was calculated. Insulin resistance (R HOMA ) was determined by homeostatic model assessment (HOMA). Results: 35 HD patients (14 with T2DM) distinguished by a higher age (median: 70 vs. 55 y, p < 0.01) in T2DM patients were studied. Glucose kinetic data showed only small differences between patients with or without T2DM, but as R HOMA measured in all patients increased, a larger fraction of glucose was removed by the extracorporeal system (r = 0.430, p = 0.01).One hour after glucose bolus injection the glucose level was not different from that before HD also in patients with T2DM (p = 0.115). Conclusions: The larger glucose amount recovered in dialysate in patients with increasing R HOMA indicates that impaired glucose disposal could be measured during HD using a non-invasive dialysis quantification approach without blood sampling. Glucose infusion during HD is safe also in patients with T2DM.

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Section: Introductionmentioning

confidence: 99%

Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

Niemczyk

Schneditz

Wojtecka

et al. 2021

Diabetes Research and Clinical Practice

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show abstract

“…Patients with chronic kidney disease (CKD) have many of the metabolic changes evident in patients with critical illnesses 24 . Dialysis patients are uniformly insulin‐resistant with approximately half of these patients demonstrating impaired glucose tolerance 25 .…”

Section: Introductionmentioning

confidence: 99%

“…[21][22][23] Patients with chronic kidney disease (CKD) have many of the metabolic changes evident in patients with critical illnesses. 24 Dialysis patients are uniformly insulin-resistant with approximately half of these patients demonstrating impaired glucose tolerance. 25 Given the potential antiinflammatory effects of an insulin infusion, and the apparent chronic inflammatory state in patients on haemodialysis, we hypothesize that an insulin infusion will modify markers of inflammation in this group.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…These physiologic effects could prevent secondary injury and promote renal tubular cell repair and recovery [93]. Studies also showed that intensive insulin therapy reduced mortality and the incidence of severe AKI requiring RRT [94,95]. However, the impact of this therapy on recovery has not yet been studied well.…”

Section: Interventions To Improve Renal Recoverymentioning

confidence: 99%

Acute kidney injury in the elderly population

Yılmaz

Erdem

2009

Int Urol Nephrol

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The elderly population is more prone to acute kidney injury (AKI) than younger populations. Older patients have less renal reserve because of reduced glomerular filtration rates due to anatomic/functional changes, and concomitant diseases such as hypertension, diabetes, atherosclerosis, heart failure, ischemic renal disease, and obstructive uropathy. The risk of AKI may also increase as a result of aggressive diagnostic and therapeutic procedures, which include medical agents, radiology, and surgical intervention. AKI in the elderly has a multifactorial physiopathology due to different etiologies. Studies that have specifically compared prognosis of AKI in elderly versus young over the recent years suggest that age is a predictor of long-term outcome. In most cases, the treatment of AKI is similar for all age groups. The majority of critically ill patients with AKI will eventually need renal replacement therapy (RRT). The influence of RRT on renal outcome remains a subject of intense investigation and debate. Avoiding situations that could damage the kidney is an important strategy to prevent AKI development in the elderly, besides medical and interventional therapeutics.

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Is There a Role for Intensive Insulin Therapy in Patients With Kidney Disease?

Cited by 6 publications

References 41 publications

Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

Glucose tolerance in patients with and without type 2 diabetes mellitus during hemodialysis

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

Acute kidney injury in the elderly population

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