Insulin resistance is immediately reduced after hemodialysis sessions in diabetic and nondiabetic patients with end-stage renal disease

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Abstract

Background
Insulin resistance in patients with end-stage renal disease (ESRD) is a strong independent predictor of cardiovascular death. The effect of hemodialysis sessions on the state of insulin resistance in patients with ESRD was not very clear. The aim of this study was to assess the immediate effect of hemodialysis sessions on insulin resistance in this group of patients.
Patients and methods
This self-control study was carried out at the Alexandria Main University Hospital. The study included 100 patients with ESRD on regular maintenance hemodialysis (50 patients with type 2 diabetes mellitus and 50 patients without diabetes mellitus). Fasting plasma glucose, fasting serum insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), blood urea, serum creatinine, and arterial bicarbonate were assessed before and after the hemodialysis sessions.
Results
Before the hemodialysis sessions, the mean HOMA-IR was 4.58 in patients with diabetes mellitus and 2.37 in patients without diabetes mellitus. The levels decreased significantly to 1.28 in patient with diabetes mellitus (<0.001) and decrease to 0.7 in patient without diabetes mellitus (<0.001) after the hemodialysis sessions. There was a significant negative correlation between HOMA-IR and serum creatinine levels before or after the hemodialysis sessions.
Conclusion
Hemodialysis sessions may cause an immediate improvement in the insulin resistance state in patients with ESRD. The variability of insulin resistance following hemodialysis sessions can lead to marked glycemic fluctuations. Careful monitoring of blood glucose level following hemodialysis sessions may be indicated in some patients with ESRD.

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