The effect of hepatitis C virus infection on insulin resistance in chronic haemodialysis patients

Abstract

PurposeTo investigate the contribution of HCV infection to insulin resistance in chronic haemodialysis patients.Materials and MethodsThe study was performed with 55 patients who were on regular haemodialysis therapy three times per week. Of the 55 patients, 34 (20 females and 14 males with an average age of 40.9 years) were anti-HCV (+) and were defined as the HCV (+) group. The remaining 21 patients (8 females and 11 males with an average age of 50 years) were negative for HCV and other viral markers and were defined as the HCV (-) group. BMI of all patients were below 27. Insulin resistance (IR) was calculated according to the HOMA formula and patients were called HOMA-IR (+) if their HOMA scores were higher than 2.5. All of the HOMA-IR (+) patients in both groups were called the HOMA-IR (+) subgroup. None of the patients had a history of drug use or any diseases that were related to insulin resistance except uremia. In both groups and the healthy control group, insulin and glucose levels were studied at three different venous serum samples taken at 5-minute intervals after 12 hours of fasting. Other individual variables were studied at venous serum samples taken after 12 hours of fasting.ResultsHOMA scores were 32.5 in 22 of 34 HCV (+) patients (64.7%) and 7 of 21HCV (-) patients (33.33%) (p = 0.024). Insulin levels of HCV (+) group (13.32 ± 9.44mIU/mL) were significantly higher than HCV (-) (9.07 ± 7.39mIU/mL) and the control groups (6.40 ± 4.94mIU/ mL) (p = 0.039 and p = 0.021 respectively). HCV (+) patients were younger (40.94 ± 17.06 and 52.62 ± 20.64 years, respectively) and had longer dialysis duration (7.18 ± 3.61 and 2.91 ± 2.69 years, respectively). Significant positive correlations of HOMA score with insulin (r = 0.934, p=0.000) and fasting glucose levels (r = 0.379, p = 0.043) were found in the HOMA-IR (+) subgroup. Also, a significant positive correlation was found between ALT and insulin levels in the HOMA IR (+) subgroup. C-peptide levels of both HCV (+) and (-) groups were significantly higher than the control group (p < 0.001). There were not any significant correlations between HOMA score and some of the other individual variables including levels of triglyceride, ferritin, ALT, iPTH and Mg in any of the groups.ConclusionIn chronic haemodialysis patients; HCV infection is related to a high prevalence of insulin resistance, higher insulin and glucose levels.

The Effect of Hepatitis C Virus Infection on Insulin Resistance in Chronic Hemodialysis Patients

“…As regard age and sex distribution in our study there were no significant differences among group 1 and group 2, these results were in agreement with Tsai et al, [11] and Ozdemir et al, [12] . In comparison of clinical data of group 1 and group 2, therewere no statistical significant differences between the two groups regarding height, systolic blood pressure and diastolic blood pressure.…”

“…We found special laboratory tests of group 1 and group 2 showed that there were no significant differences between the two groups regarding fasting insulin, fasting C peptide, fasting glucose, HOMA-IR and insulin resistance. These results are in agreement with Tsai et al, [11] and Adam et al, [19] , and against Ozdemir et al, [12] and this can be explained by other factors played role in our study including efficacy of dialysis, relatively small number of patients and BMI was significantly higher in group 2. As regard HOMA-IR in between low URR subgroups in group 1 versus group 2 and in between high URR subgroups in group 1 versus group 2 there were no significant differences but HOMA-IR was significantly higher with low URR subgroup of group 1 versus high URR subgroup of group 1.…”

“…In comparison of clinical data of group 1 and group 2, therewere no statistical significant differences between the two groups regarding height, systolic blood pressure and diastolic blood pressure. Dialysis duration was longer significantly in group 1 with mean duration 7.93 ± 5.25 years and these results were in agreement with Tsai et al, [11] and Ozdemir et al, [12] . This can be explained by the longer the dialysis duration the higher the chance of nosocomial transmission of HCV due to sharing items between patients, contamination of dialysis machines, contaminated gloves used by working nurses and lack of proper sterilization of machines after each dialysis session [13] .…”

Visfatin and endogenous secretory receptor for advanced glycation end-products in diabetic type 2 and non-diabetic patients undergoing intermittent hemodialysis

“…HOMA-IR closely mirrors the clamp technique in the assessment of insulin sensitivity in subjects with various degrees of glucose tolerance and insulin sensitivity, also in type 2 diabetic patients treated with hypoglycemic agents [30,31]. HOMA-IR has also been applied to nondiabetic patients: with end-stage renal disease [32,33], treated with IHD [33][34][35][36][37][38][39][40][41][42] or peritoneal dialysis [42][43][44][45][46]. Shoji et al [47] demonstrated the usefulness of HOMA-IR to assess insulin resistance in renal failure patients; they also included insulin users into the study.…”

Cardiovascular Risk in Tunisian Patients with Bipolar I Disorder

“…IR was defined as the upper quartile of HOMA-IR. Values above 2.5 were taken as abnormal and reflect insulin resistance (Ozdemir et al, 2007). Bipolar patients with diabetes (n = 21) were excluded in the HOMA-IR analysis.…”