title: Relationship of insulin resistance in chronic haemodialysis patients with inflammatory indicators, malnutrition, echocardiographic parameters and 24 hour ambulatory blood pressure monitoring.
abstract: 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.
authors.affiliation: Department of Nephrology, Celal Bayar University Medical Faculty, Manisa, Turkey.
authors.forename: Seyhun
authors.initials: S
authors.lastname: Kurşat
authors.forename: Hulya Bahadir
authors.initials: HB
authors.lastname: Colak
authors.forename: Aysun
authors.initials: A
authors.lastname: Toraman
authors.forename: Hikmet
authors.initials: H
authors.lastname: Tekçe
authors.forename: Cevval
authors.initials: C
authors.lastname: Ulman
authors.forename: Ozgur
authors.initials: O
authors.lastname: Bayturan
mesh_terms: 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