Insulin resistance and muscle wasting in non-diabetic end-stage renal disease patients.
BACKGROUND
Insulin resistance (IR) is prevalent in uraemia. Recent experimental studies suggested IR to be a central mechanism for uraemic malnutrition. However, it is not known whether IR is related to muscle wasting in non-diabetic end-stage renal disease (ESRD) patients.


METHODS
We cross-sectionally assessed IR and muscle wasting in 21 non-diabetic ESRD patients who admitted for the initiation of dialysis. For the assessment of muscle wasting, lean body mass was measured (LBMm) by dual energy X-ray absorptiometry and compared with the estimated LBM (LBMe) from the prediction equation derived from healthy controls using the ratio of LBMm/LBMe. For measurement of IR, the homoeostasis model (HOMA-IR) was used. In addition, among patients who chose continuous ambulatory peritoneal dialysis, muscle was sampled during catheter insertion from the rectus abdominis to measure 14-kDa actin fragments, a marker of muscle protein degradation.


RESULTS
Patients with a low LBMm/LBMe ratio (<1.00) showed higher HOMA-IR and fat mass (FM) (% body weight) and lower LBM (% body weight) than those with a high LBMm/LBMe ratio (>or=1.00). LBMm/LBMe ratio was negatively correlated with HOMA-IR, regardless of obesity. By multiple regression analysis, HOMA-IR was an independent factor affecting LBMm/LBMe ratio. Furthermore, in the muscle samples, patients with high HOMA-IR had lower LBMm/LBMe ratios and stronger bands for the 14-kDa actin fragments than did patients with low HOMA-IR.


CONCLUSIONS
These results suggest that IR seems to be associated with muscle wasting in non-diabetic ESRD patients.
Lee
Seoung Woo
SW
Department of Internal Medicine, Inha University College of Medicine, Inchon, and Kidney Center, Inha University Hospital, 7-206, 3-Ga, Sinhung-Dong, Jung-Gu, Inchon city, Korea.
Park
Geun Ho
GH
Lee
Seung Won
SW
Song
Joon Ho
JH
Hong
Kee Chun
KC
Kim
Moon-Jae
MJ
D000199:Actins / Q000378:metabolism; D001835:Body Weight; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000473:pathology*; D005260:Female; D006706:Homeostasis; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000150:complications*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012044:Regression Analysis; D013851:Thinness
D000199:Actins