Abstract

Introduction: Insulin resistance (IR) is a risk factor for Cardiovascular mortality in ESRD patients. This study measured IR in patients with ESRD using homeostasis model assessment (HOMA)–IR model, and then derived insulin sensitivity (HOMA-%S) and beta cell function (HOMA-%B).

Material: The study was done between December 2016 and May 2017. Participants were divided into 2 groups: CKD stage V not on dialysis (CKDV-ND) and CKD V on hemodialysis (CKDVD). Fasting blood glucose, fasting insulin level and c-peptide were measured and IR, HOMA-%S, HOMA-%B were calculated by HOMA using Insulin level (IR-Ins) and C-peptide (IR-cp) level. GFR<15ml/min/1.73m2 was used to define ESRD.

Observations: The study included 20 patients in CKDV-ND and 22 patients in CKDVD group. The mean HOMA scores of IR-Ins were 0.56 ± 0.1 and 1.37 ± 0.9, while mean IR-cp were 5.1 ± 2.1 and 3.2 ± 1.7 in CKDVD and CKDVND groups respectively (p<0.01). Mean fasting plasma insulin levels were 9.8 ± 6.3 μU/mL in CKDV-ND, and 4.35 ± 0.7 μU/mL in CKDVD group (p<0.001). The HOMA-%B values were not statistically significant between groups (p=0.16), but HOMA-%S levels were significantly higher in the CKDVD group (P<0.001). The HOMA-%B using c-peptide was significantly higher in the CKDVD group (p<0.001). The IR-ins showed significant association with CRP levels in both the groups (p<0.05). IR-cp was significantly higher in the both the groups compared to IR-Ins (p<0.001), and was higher in the CKDVD group (p<0.001).

Conclusion: IR-Ins was decreased in CKDVD group compared to CKDV-ND, while IR-cp was higher in the dialysis group. Insulin sensitivity and beta cell function were also better in the dialysis group. This could reflect altered insulin dynamics or better control of uremia with dialysis. Measurement of IR using c-peptide could be a better method in patients with CKD.

Keywords: Insulin resistance, HOMA-IR, HOMA-%B, HOMA-%S c-peptide, CKD, ESRD.