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HEMODİYALİZ HASTALARINDA İNSÜLİN DİRENCİ ÜZERİNE PARATHORMONUN ETKİSİ

THE EFFECT OF PARATHYROID HORMONE ON THE INSULIN RESISTANCE IN HEMODIALYSIS PATIENTS

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Abstract (2. Language): 
The purpose of this study was to investigate whether the parathyroid hormone (PTH) level affects insulin resistance in hemodialysis patients. 28 hemodialysis patients were divided into three groups according to their PTH levels as normal, high and very high groups. Intravenous glucose tolerance test lasting 120 minutes was applied to all patients. Glucose and insulin values were determined and the total areas under the curves of glucose and insulin were calculated. We did not find a significant difference between the stimulated glucose levels of each group. But insulin responses of group with very high PTH levels were significantly higher than those of the groups with normal and high PTH levels. Although there was no difference between total areas under glucose curves of three groups, total area under insulin curve of the group with very high PTH level was higher than those of other groups. The results suggest that the moderately high PTH level in hemodialysis patients does not affect insulin resistance and insulin release from the pancreas independent of the calcium, ionized calcium and phosphate levels. In addition, we came to the conclusion that the very high PTH levels increased insulin resistance by elevating the insulin levels.
Abstract (Original Language): 
Bu çalışma paratiroid hormon (PTH) seviyelerinin hemodiyaliz hastalarında insülin direnci üzerine etkisinin araştırılması amacıyla planlanmıştır. 28 hemodiyaliz hastası PTH seviyelerine göre normal, yüksek ve çok yüksek olmak üzere 3 gruba ayrüddar. Tüm hastalara 120 dakikalık sık örneklemeıi intravenöz glikoz tolerans testi (İVGTT) yapıldı. Senim glikoz ve insülin değerleri ve insülin ve glikoz eğrilerinin altındaki total alanlar hesaplandı. IVGTT'ne her üç grubun glikoz cevapları arasında anlamlı bir fark bulunmadı. F.akat çok yüksek PTH düzeyli gruptaki insülin cevapları normal vö yüksek PTH seviyeli gruplara göre anlamlı yüksekti. Her üç grubun glikoz eğrileri altında kalan total alanlar arasında anlamlı bir fark olmamasına karşın, sadece çok yüksek PTH düzeyli grubun insülin eğrisi altında kalan alan diğer gruplardan anlamlı olarak daha yüksekti. Bu sonuçlar, hemodiyaliz hastalarında orta derecede yüksek PTH düzeylerinin, kalsiyum, iyonize kalsiyum ve fosfat seviyelerinden bağımsız olarak insülin direncini ve pankreastan insülin salınımını etkilemediğini düşündürmektedir. Ayrıca, çok yüksek PTH düzeylerinin insülin seviyelerini yükselterek insülin direncini artırdığı kanaatine vardık.
FULL TEXT (PDF): 
168-172

REFERENCES

References: 

1. DeFronzo RA, Alvestrand A, Smith D, Hcndler R, Hendler E, Wahren J. İnsülin resistance in uremia. J Clin Invest 1981; 67(2): 563-568.
2. Mak RHK, DeFronzo RA. Glucose and insülin metabolism in uremia. Nephron 1992; 61: 377-382.
3. Dzurik R, Hupkova V, Cernacek P. The isolation of an inhibitor of glucose utilization from the serum of uremic subjects. Clin Chim Acta 1983; 46:77.
4. Silver J, Moallem E, Kilav R, Epstein E, Sela A, Naveh-Many T. New insights into the regulation of parathyroid hormone synthesis and secretion in chronic renal failure. Nephrol Dial Transplant 1996; 11 (Supnl 3): 2-5. / ' /
5. Fadda G Z, Massry SG. Glucose and insulin metabolism. In Massry SG and Glassock RJ. Textbook of Nephrology. Williams & Williams, Baltimore, 1995, p: 1390-1396.
6. Fadda GZ, Akmal M, Premdas FH, Lipson LG, Massry SG. Insulin release from pancreatic islets: effects of CRF
and excess PTH. Kidney Int 1988; 33(6): 1066-1072.
7. Graf H, Prager R, Kovarik J, Luger A, Schernthaner G, Pinggera WF. Glucose metabolism and insulin sensitivity in patients on chronic hemodialysis.
Metabolism 1985; 34(10): 974-977.
8. Rodriguez M, Felsenfeld AJ, Williams C, Pederson JA, Llach F. The effects of long-term intravenous calcitriol administration on parathyroid function in hemodialysis
patients. J Am Soc Nephrol 1991; 2(5): 1014-1020.
9. Akmal M, Massry SG, Goldstein DA, Fanti P, Weisz A,
DeFronzo R. Role of parathyroid hormone in the glucose intolerance of chronic renal failure. J Clin Invest 1985; 75(3): 1037-1044.
10. Smith D, DeFronzo RA. Insulin resistance in uremia mediated by postbinding defects. Kidney Int 1982;
22(l):54-62.
11. Mak RHK. Effect of metabolic acidosis an insulin action and secretion in uremia. Kidney Int 1998; 54: 603-606.
12. Mak RHK, Bertinelli A, Turner C, Haycock B, Chantler C. The influence of hyperparathyroidism on glucose metabolism in uremia. J Clin Endocrinol Metab 1985;
60(2): 229-233.
13. Amend WJC, Steinberg SM, Lowrie EG. The influence of serum calcium and parathyroid hormone upon glucose metabolism in uremia. J Lab Clin Med 1975; 86: 435.
14. Bergesio F, Bandini S, Cresci B Monzani G, Rotella C, Conti A, Rosati A, Piperno R, Messeri G, Frizzi V, Salvadori M. Hyperparathyroidism: is it really the major factor affecting glucose tolerance in uremia? Miner
Electrolyte Metab 1996; 22 (1-3): 187-191.
15. Phillips DI, Clark PM, Hales CN, Osmond. Ç,
Understanding oral glucose tolerance: comparison of
glucose or insulin measurements during the oral glucose tolerance test with specific measurements of insulin resistance and insulin secretion. Diabet Med 1994; 3: 286-292.
16. Mattheus DR, Hosker JP, Rudenski AS, Naylor DA,
Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and -cell function from fasting plasma glucose and insulin concentrations in
man. Diabetologia 1985; 28: 412-419.
; 17.
Apaydın S, Altıparmak MR, Uzunoğlu S ve ark. Kronik böbrek yetmezliğinde karbonhidrat metabolizması ve parathormon ilişkisi. Türk Nefroloji Diyaliz ve
Transplantasyon Dergisi 1998; 4: 192-196.
18. Norman AW, Frankel JB, Heldt AM, Grodsky GM.
Vitamin D deficiency inhibits pancreatic secretion of
insulin. Science 1980; 209(4458): 823-825.
19. Clark SA, Stumf WE, Sar M, Deluca HF, Tanaka Y. Target cells for 1.25-dihydroxyvitamin D3 in pancreas.
Cell Tissue Res 1980; 209(3): 515-520.
20. Roth J, Bonner-Weir S, Norman AW, Orci L.
Immunocytochemistry of vitamin D dependent calcium binding protein in chick pancreas exclusive localization. Endocrinology 1982; 110(6): 2216-2218.
21. Kautzky-Willer A, Pacini G, Barnas U, Ludvik B, Streli C, Graf H, Prager R. Intravenous calcitriol normalizes insulin sensitivity in uremic patients. Kidney Int 1995;
47: 200-206.
22. Mak RHK. 1,25-Dihydroxyvitamin D3 corrects insulin and lipid abnormalities in uremia. Kidney Int 1998; 53: 1353-1357.
23. Vareesangthip K, Tong P, Wilkinson R, Thomas TH. Insulin resistance in adult polycystic kidney disease.
Kidney Int 1997;52:503-508.
24. Fliser D, Pacini G, Engelleiter R, Kautzky-Willer A, Prager R, Franek E, Ritz E. Insulin resistance and hyperinsülinemia are already present in patients with incipient renal disease. Kidney Int 1998; 53: 1343-1347.
25. Fliser D, Franek E, Fode P, Stefanski A, Schmitt CP,
Lyons M, Ritz E. Subacute infusion of physiological doses of parathyroid hormone raises blood pressure in
humans. Nephrol Dial Transplant 1997; 12: 933-938.

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