Relationship of insulin resistance in chronic haemodialysis patients with inflammatory indicators, malnutrition, echocardiographic parameters and 24 hour ambulatory blood pressure monitoring.
OBJECTIVE
The relationship between malnutrition, echocardiographic parameters, 24 h ambulatory blood pressure (ABP) parameters and decreased insulin sensitivity index (ISI-S) in chronic haemodialysis patients was investigated.


METHODS
ISI-S and inflammatory indicators were measured. The nutritional state was assessed by malnutrition score. Echocardiography and 24 h ABP were performed 1 day before the second haemodialysis session of the week.


RESULTS
ISI-S was inversely correlated with the night-time mean blood pressure (BP)/day-time mean BP ratio (p = 0.021) and malnutrition score (p < 0.01). High-sensitivity C-reactive protein, night-time mean BP/day-time mean BP and vena cava collapse index were independent risk factors affecting ISI-S (p < 0.001; beta = 0.412, p = 0.025; beta = -0.204, p < 0.001; beta = -0.465).


CONCLUSIONS
The decrease in ISI-S along with the hypervolaemia suggests that volume overload is a contributory factor in the pathogenesis of insulin resistance in patients with chronic renal failure. This study indicates that, in addition to the traditional cardiovascular risk factors in these patients, insulin resistance can be regarded as a risk factor, but not an independent one, mainly a reflection of the underlying culprit, hypervolaemia.
Kurşat
Seyhun
S
Department of Nephrology, Celal Bayar University Medical Faculty, Manisa, Turkey.
Colak
Hulya Bahadir
HB
Toraman
Aysun
A
Tekçe
Hikmet
H
Ulman
Cevval
C
Bayturan
Ozgur
O
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000503:physiopathology*; D007333:Insulin Resistance / Q000502:physiology*; D007674:Kidney Diseases / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000503:physiopathology*; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000503:physiopathology