title: Homeostatic model assessment indices in evaluation of insulin resistance and secretion in hemodialysis patients.
abstract: BACKGROUND
  Some previous observations suggest that insulin resistance and glucose metabolism disturbances are frequent complications of chronic kidney disease. However, there are no conclusive studies on other indices of the effectiveness of insulin action in end-stage renal disease (ESRD) patients, including chronically hemodialysed (HD) ones.
  
  
  METHODS
  The groups comprised 33 non-diabetic ESRD hemodialysed patients and 33 healthy controls matched for age, sex, and body mass index (BMI). In both groups, HOMA-%B, HOMA-%S, HOMA-IR indices, and DI were calculated using HOMA1 and HOMA2 as measures of insulin resistance. The indices were also assessed in subgroups divided according to BMI.
  
  
  RESULTS
  Mean fasting plasma glucose concentrations were lower in ESRD patients than in healthy persons (82.4±10.4 vs. 93.9±11.6, p=0.001). Fasting serum insulin concentrations were similar in both groups (median 6.8 vs. 6.0 mU/l, p=0.698). HOMA1-%B values were higher in ESRD patients than controls (median 137.1 vs. 81.6, p=0.002). HOMA1-%S (median 75.6 vs. 71.5) and HOMA1-IR (median 1.3 vs. 1.4) values were not significantly different (p=0.264 and p=0.189, respectively). DI1 levels were higher for HD patients than for healthy subjects (median 1.16 vs. 0.53, p<0.001). In subgroup analysis, all statistically significant differences were restricted mainly to persons with BMI <25 kg/m2. Similar results as for the HOMA1 model were obtained for HOMA2.
  
  
  CONCLUSIONS
  1. HOMA beta-cell function is strongly correlated with HOMA insulin resistance in HD patients. 2. In non-diabetic ESRD hemodialysed patients, the HOMA indices and DI may be useful and important models in interpretation of glucose metabolism disturbances.
authors.affiliation: Nephrology Clinic, Military Institute of Medicine, Medical University of Warsaw, Warsaw, Poland. sniemczyk@wim.mil.pl
authors.forename: Stanisław
authors.initials: S
authors.lastname: Niemczyk
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Szamotulska
authors.forename: Kinga
authors.initials: K
authors.lastname: Giers
authors.forename: Mariusz
authors.initials: M
authors.lastname: Jasik
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Bartoszewicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Romejko-Ciepielewska
authors.forename: Ewa
authors.initials: E
authors.lastname: Paklerska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Gomółka
authors.forename: Joanna
authors.initials: J
authors.lastname: Matuszkiewicz-Rowińska
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000097:blood; D004198:Disease Susceptibility / Q000097:blood; D005215:Fasting / Q000097:blood; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism; D007676:Kidney Failure, Chronic / Q000097:blood; D008875:Middle Aged; D008954:Models, Biological; D006435:Renal Dialysis
chemical_list: D001786:Blood Glucose; D007328:Insulin