Insulin resistance and glucose homeostasis in peritoneal dialysis.
Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.
Fortes
Paulo Cezar
PC
Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
de Moraes
Thyago Proença
TP
Mendes
Jamille Godoy
JG
Stinghen
Andrea E
AE
Ribeiro
Silvia Carreira
SC
Pecoits-Filho
Roberto
R
D001786:Blood Glucose / Q000378:metabolism*; D050171:Dyslipidemias / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D024821:Metabolic Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D009017:Morbidity; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
D001786:Blood Glucose