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Effect of hemodialysis on glucose tolerance in children with chronic renal failure
Insights
Children with chronic kidney disease show impaired glucose tolerance. While hemodialysis offers no acute benefits, it may improve glucose tolerance long-term by enhancing insulin release.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Metabolic Disorders
Background:
- Children with uremia often exhibit altered glucose metabolism.
- Chronic renal failure impacts carbohydrate tolerance and insulin secretion.
Purpose of the Study:
- To assess glucose tolerance and insulin response in children with chronic kidney disease.
- To evaluate the acute and long-term effects of hemodialysis on glucose metabolism.
Main Methods:
- Intravenous glucose tolerance tests were performed in non-dialyzed children, hemodialysis patients (before and after), and healthy controls.
- Plasma glucose, insulin, and free fatty acid levels were measured.
- Long-term follow-up of hemodialysis patients at three and six months.
Main Results:
- Non-dialyzed uremic children had hyperglycemia with a normal insulin response and diabetic-range glucose clearance.
- Hemodialysis showed no acute improvement in glucose levels or clearance rates.
- Hemodialysis patients exhibited hyperinsulinemia, which increased over time, suggesting improved pancreatic insulin release.
Conclusions:
- Chronic hemodialysis does not acutely improve glucose metabolism in children with renal failure.
- Long-term hemodialysis may enhance pancreatic insulin release, potentially improving glucose tolerance and carbohydrate tolerance by overcoming insulin resistance.
Abstract:
Five uremic (7.0 - 15.2 years), non-dialyzed children treated medically (group 1) had an intravenous glucose tolerance test (0.5 g/kg). Blood samples were obtained at frequent intervals and duplicate determinations of plasma glucose (glucose-oxidase method on Somogyi-Nelson protein-free filtrates), insulin and free fatty acids were performed. The same study was performed in eleven children (12.3 - 18.0 years) with chronic renal failure undergoing long-term hemodialysis (group 2), before and two hours after dialysis. Results were compared to a group (group 3) of eight healthy children (7.5 -- 17.5 years). In group 1 a "normal" insulin response was observed in the presence of hyperglycemia and the plasma glucose clearance was in the diabetic range. Twice weekly hemodialysis produced no beneficial acute effects on group 2, based on absolute glucose values or plasma glucose clearance rates, on groups as well as on individual basis; however, a clear hyperinsulinemia was present which was of even higher magnitude three and six months after the initial study. These results demonstrated that chronic hemodialysis had no beneficial acute effects on plasma glucose concentration or plasma glucose clearance rate. However, it may have obvious long term beneficial effects on glucose tolerance by enhancing pancreatic insulin release (to overcome peripheral insulin resistance) to such an extent as to maintain a normal carbohydrate tolerance.