The beneficial effect of effective control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries

Abstract

We report the beneficial effect of control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries. The patient's hemoglobin (Hb) level of 10.3 g/dl on admission represents good control for hemodialysis (HD) patients, but it was too low for this patient with secondary polycythemia because of a right-to-left shunt. Control of anemia for a 10-month period was followed by a marked increase in Hb level (from 10.3 g/dl to 13.9 g/dl) and in aerobic work capacity, while the fasted insulin level decreased from 36.7 microU/ml to 8.0 microU/ml, without changes in leptin level, body mass index (BMI), fat mass, Kt/V, or protein catabolic rate (PCR). Additionally, hypoxemia was ameliorated, from PO2 33.1 mmHg to PO2 56.2 mmHg, and the hyperdynamic cardiac state was improved. The degree of anemia, together with deteriorating tissue oxygenation, may have predisposed this patient to developing insulin resistance and consequent hyperinsulinemia. The most appropriate target Hb concentration should be tailored for the clinical condition of each individual patient, bearing in mind an insulin-resistance state, especially in hemodialysis patients with hypoxemia. A more complete understanding of what regulates insulin resistance and consequent hyperinsulinemia in endstage renal disease (ESRD) awaits the elucidation of carbohydrate and insulin metabolism.

Serum Ferritin Level is an Independent Predictor of Insulin Resistance in Non-diabetic Men Aged Between 30-69 Years: Korean National Health and Nutrition Examination Survey 2008-2010

“…Serum ferritin concentration is marker of iron stores in the body 13 as well as systemic inflammation 6 and is associated with the amount of heme-iron intake: hemeiron intake 14 and anemia [14][15][16] also have been reported to be independently associated with insulin resistance or metabolic disease. Furthermore, central adiposity, an important risk factor of insulin resistance, is also associated with ferritin level.…”

Acute Effects of Blood Transfusion on Insulin Sensitivity and Pancreatic β-Cell Function in Children with β-Thalassemia/Hemoglobin E Disease

“…Among patients with chronic renal failure treated with hemodialysis, moderate to severe anemia was also a risk factor for insulin resistance ( 10 , 11 , 12 , 27 ). Partial correction of anemia with erythropoietin was shown to reduce insulin resistance as well as reduce insulin secretion ( 11 , 12 ).…”

“…Previous studies of chronic renal failure patients treated with multiple episodes of hemodialysis reported that low hematocrit (Hct) may induce tissue hypoxia and cause insulin resistance. Erythropoietin treatment improves the anemic state and reduces insulin resistance in these patients ( 10 , 11 , 12 ).…”

Chronic Kidney Disease; Study on Patterns of Anemia in Relation to Glomerular Filtration Rate (Gfr) in Patients

“…1 According to above explanation, almost 90 percent of patients with a glomerular filtration rate (GFR) short of what 25 to 30 mL / min have anemia, numerous with Hemoglobin levels below 10 g/dL. 2 Without treatment, the anemia of chronic kidney disease (CKD) cause number of physiologic abnormalities and pathological problems including decreased tissue oxygen delivery and utilization, 3 , cardiac enlargement,increased cardiac output ,angina, ventricular hypertrophy, congestive heart failure, 4,5 decreased cognition and mental acuity, menstrual issues, decreased nocturnal penile tumescene, and impaired immune achievements. 6 Normocytic normochromic anemia is most overwhelming s finding of Chronic Renal Disease patients, in additions, anemia may result in growth retardation and decreased intellectual efficiency in pediatric patients.…”