title: The beneficial effect of effective control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries.
abstract: We report the beneficial effect of control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries. The patient's hemoglobin (Hb) level of 10.3 g/dl on admission represents good control for hemodialysis (HD) patients, but it was too low for this patient with secondary polycythemia because of a right-to-left shunt. Control of anemia for a 10-month period was followed by a marked increase in Hb level (from 10.3 g/dl to 13.9 g/dl) and in aerobic work capacity, while the fasted insulin level decreased from 36.7 microU/ml to 8.0 microU/ml, without changes in leptin level, body mass index (BMI), fat mass, Kt/V, or protein catabolic rate (PCR). Additionally, hypoxemia was ameliorated, from PO2 33.1 mmHg to PO2 56.2 mmHg, and the hyperdynamic cardiac state was improved. The degree of anemia, together with deteriorating tissue oxygenation, may have predisposed this patient to developing insulin resistance and consequent hyperinsulinemia. The most appropriate target Hb concentration should be tailored for the clinical condition of each individual patient, bearing in mind an insulin-resistance state, especially in hemodialysis patients with hypoxemia. A more complete understanding of what regulates insulin resistance and consequent hyperinsulinemia in endstage renal disease (ESRD) awaits the elucidation of carbohydrate and insulin metabolism.
authors.affiliation: Department of Internal Medicine, Takasago Municipal Hospital, 33-1 Kamimachi, Arai-cho, Takasago 676-8585, Japan. n-igaki@gk9.so-net.ne.jp
authors.forename: Naoya
authors.initials: N
authors.lastname: Igaki
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Takashima
authors.forename: Minako
authors.initials: M
authors.lastname: Ohyama
authors.forename: Suirin
authors.initials: S
authors.lastname: Oh
authors.forename: Aritoshi
authors.initials: A
authors.lastname: Kida
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yanase
authors.forename: Makoto
authors.initials: M
authors.lastname: Sakai
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Tamada
authors.forename: Takeo
authors.initials: T
authors.lastname: Goto
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D005260:Female; D005951:Glucose Tolerance Test; D006454:Hemoglobins; D006801:Humans; D006946:Hyperinsulinism / Q000150:complications / Q000628:therapy*; D000860:Hypoxia / Q000150:complications / Q000628:therapy*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis; D014188:Transposition of Great Vessels / Q000150:complications* / Q000601:surgery
chemical_list: D006454:Hemoglobins; D007328:Insulin