Insulin resistance in uremia: effect of dialysis modality

Insulin sensitivity was studied before and after 3 mo of continuous cycling peritoneal dialysis (CCPD) in seven uremic patients, before and after 3 mo of hemodialysis (HD) in another seven uremic patients, and in seven healthy controls. There were no significant differences in the height, weight, anthropometric measures, or intakes of protein and total calories between the CCPD and the HD groups before and after the 3 mo of dialysis therapy. There were no differences in other biochemical parameters between patients on CCPD and patients on HD either at the initiation of dialysis or at the end of 3 mo of dialysis therapy. Residual renal function was not different between the two groups. Mean Kt/Vurea in the CCPD group was 2.10/wk and that for the HD group was 1.20/session. The CCPD group and the HD group both had higher fasting glucose concentrations (p < 0.02), but normal fasting serum immunoreactive insulin concentrations compared with controls. The hyperinsulinemic euglycemic clamp technique was used to measure insulin sensitivity. Before dialysis, insulin sensitivity was low in both patient groups (CCPD 128 +/- 11 mg/m2/min; HD 130 +/- 11) compared with controls (320 +/- 26) (p < 0.01 in both cases) but not different between the patient groups. After 3 mo of dialysis therapy, insulin sensitivity increased by 80 +/- 7% in the CCPD group and by 38 +/- 4% in the HD group (p < 0.01 compared with predialysis values in both groups). Insulin sensitivity in both groups after 3 mo of dialysis was still lower than in the control group (p < 0.01 in both cases). However, both the percentage increase as well as the final insulin sensitivity were significantly higher in the CCPD group (230 +/- 19 mg/m2/min) than the HD groups (179 +/- 16) (p < 0.01 in both cases).