[Renal failure and insulin resistance: effect of the dialysis dose].
BACKGROUND
The main cause of death in patients undergoing hemodialysis are cardiovascular events. We have analyzed the association between intradialysis fractional clearance of urea or Kt/V index in patients with chronic renal failure in hemodialysis as an indicator of adequate dialysis and the classical factors of cardiovascular risk.


METHODS
A total of 47 patients with chronic renal failure on hemodialysis were included. Diabetes mellitus was considered an exclusion criteria. Optimization of dialysis was analyzed by Kt/v index in accordance with the Daugirdas formula. The cardiovascular risk factors evaluated were: insulin resistance, calculated according to the HOMA method, total cholesterol, LDL-cholesterol, triglycerides, arterial hypertension, obesity and metabolic syndrome. The relationship between cardiovascular risk factors and Kt/V index was analyzed with the variant and multivariant analysis.


RESULTS
The HOMA median (interquartile range) of the patients was 1.16 (0.53-5.77). HOMA was correlated with triglycerides and HDL-cholesterol levels. HOMA was significantly greater in those who had less adapted dialysis (Kt/V < 1.4) (1.9 +/- 1.3 vs 1.0 +/- 0.3, p = 0.02). Furthermore, a negative correlation was found between HOMA and Kt/V. The multivariant analysis of the factors associated to HOMA demonstrated that the only associated parameters were Kt/V greater than 1.4, body mass index and age.


CONCLUSIONS
In patients with chronic renal failure, adapted dialysis, determined by the Kt/V index, correlated negatively with insulin resistance. Based on these data, we suggest the need for longitudinal studies that consider this index as a predictive variable of cardiovascular events in this type of patients.
Mínguez
C
C
Servicio de Nefrología. Hospital Universitario Puerta del Mar. Cádiz. España.
López-Suárez
A
A
Soto
M J
MJ
Ceballos
M
M
Bailén
M A
MA
Benítez
E
E
Girón-González
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015312:Hemodialysis Solutions / Q000008:administration & dosage*; D006801:Humans; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D015312:Hemodialysis Solutions