The effect of two different high-flux dialysis membranes on insulin resistance in non-diabetic end-stage renal disease patients

Abstract

Objective: The aim of this study was to investigate the effect of two different types of high-flux dialysis membranes on insulin resistance among patients who are receiving hemodialysis (HD) due to end-stage renal failure (ESRF). Materials and methods: Forty-six (21 female, 25 male) patients were included in the study, who were on HD treatment due to stage-5 chronic renal failure. Prior to the study, fasting insulin resistance via Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) and fractioned urea clearance (Kt/V) values were calculated using the urokinetic model. The polysulfone (PS) dialysis membrane of all patients included in the study was replaced with ''polyarylethersulfone, polyvinylpyrrolidone, polyamide (PPP)'' high-flux membrane that has the same surface area over 12 weeks. At the end of the 12-week period, HOMA and Kt/V values were recalculated. Results: At the end of the 12-week period, Kt/V values rose statistically significant from 1.575 to 1.752 (p ¼ 0.002). HOMA-IR values declined, though not statistically significant, from 3.268 to 2.926 (p ¼ 0.085). PPP high-flux membrane increased the Kt/V values significantly compared to the PS membrane, while it decreased the insulin resistance and increased insulin sensitivity. Conclusion: The two different types of high-flux dialysis membranes used for HD have different effects on insulin sensitivity. Compared to the PS membrane, PPP high-flux membrane decreased insulin resistance by increasing insulin sensitivity among non-diabetic ESRF patients.

Phosphate depletion in insulin-insensitive skeletal muscle drives AMPD activation and sarcopenia in chronic kidney disease

“…Insulin resistance is a common finding in patients with CKD, particularly in those requiring dialysis 43 , 44 , 45 , 46 including in non-diabetic patients. 47 , 48 Even though circulating glucose levels in 14-h fasting mice undergoing CKD-dependent sarcopenia or sham operation did not differ (116.2 ± 14.7 mg/dL in mice with sarcopenia versus 107.7 ± 18.7 mg/dL in sham), insulin levels following an oral glucose exposure were significantly higher in wild type mice with sarcopenia ( Figures 2 A and 2B, black symbols). Of interest, this increase seems to be the consequence of reduced clearance of insulin as there was not a significant difference in insulin peak release following glucose exposure (40′ after glucose challenge) between sarcopenia and sham.…”

Thyroid dysfunction and insulin resistance in end‐stage renal disease patients before and 1 year after starting maintenance hemodialysis: A prospective multicenter study

“…This was in concordance with the results demonstrated by Satirapoj et al 39 IR in ESRD is multifactorial, and it was believed to be afflicted by metabolic acidosis, certain uremic toxins, uremiarelated impairment of glucose metabolism, anemia, hyperparathyroidism, malnutrition, vitamin D deficiency, and high proinflammatory cytokines. 40 Therefore, adequate dialysis could alleviate these factors and hence reduce IR and improve insulin sensitivity. There was a significant correlation between ΔCRP and ΔHOMA-IR.…”