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C-peptide kinetics following an intravenous glucose load in children undergoing regular hemodialysis
M Bulla1, T Ronda-Vildosola, D Hübinger
1Children's University Hospital, Münster, FRG.
Insights
Children on hemodialysis show persistent insulin metabolism issues. Glucose kinetics do not correlate with insulin and c-peptide levels, indicating ongoing disturbances in glucose regulation and hormone secretion.
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Disorders
Background:
- Children and adolescents on regular hemodialysis often exhibit metabolic complications.
- Uremia-associated disturbances in insulin metabolism and c-peptide secretion are common in these patients.
Purpose of the Study:
- To investigate the relationship between glucose kinetics and c-peptide release in pediatric hemodialysis patients.
- To assess the impact of long-term hemodialysis on insulin metabolism and c-peptide secretion.
Main Methods:
- Intravenous glucose tolerance test (iv-GTT) was performed on 15 children and adolescents undergoing regular hemodialysis.
- Measurements included glucose kinetics, insulin levels, and c-peptide release.
- Fasting serum levels and excretion rates were analyzed.
Main Results:
- Long-term hemodialysis did not correct uremia-associated disturbances in insulin metabolism and c-peptide secretion.
- Fasting insulin and c-peptide levels remained elevated, with prolonged insulin excretion.
- Early c-peptide secretion was reduced, despite an initial increase, showing accumulation during the study.
- Glucose metabolism did not correlate with insulin and c-peptide kinetics.
Conclusions:
- Regular hemodialysis does not resolve underlying issues with insulin metabolism and c-peptide secretion in pediatric patients.
- The c-peptide secretion curve was found to be out of phase with the insulin secretion rate in this cohort.
- These findings highlight persistent metabolic dysregulation in children with chronic kidney disease requiring hemodialysis.
Abstract:
Following an intravenous glucose tolerance test (iv-GTT) we investigated the relationship between glucose kinetics and c-peptide release in 15 children and adolescents requiring regular hemodialysis. Following longterm hemodialysis, we were unable to demonstrate any correction of the uremia associated disturbances of insulin metabolism and c-peptide secretion. Fasting serum levels of insulin and c-peptide remained elevated and insulin excretion prolonged. After an increase in c-peptide levels there was an accumulation throughout the study period, early c-peptide secretion was reduced. Thus in regular hemodialysis, glucose metabolism did not correlate with insulin and c-peptide kinetics. The c-peptide secretion curve is out of phase with the insulin secretion rate.