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HEMODİYALİZ HASTALARINDA KT/V DEĞERİNİN ARTIRILMASININ İNSÜLİN DİRENCİ ÜZERİNE ETKİSİ

THE EFFECT OF INCREASED KT/V VALUES ON INSULIN RESISTANCE IN THE HEMODIALYSIS PATIENTS

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2001

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
28 outpatients with end-stage renal disease who were on hemodialysis treatment were included in the study. Kt/V values of all cases were calculated by ureakinetic modelling. During 12 weeks we tried to keep Kt/V almost equal to 1.0 in all patients. After 12 weeks 18 cases who had mean Kt/V value of 1.0+0.02 were selected as the study group. 10 cases with the mean Kt/V value of 1.1+0.02 were selected as control group. The mean age of study and control groups was 36.5+1.0 yearsand37.2+1.5 years, respectively. Among groups, there was no difference in terms of age, the duration of dialysis, parathyroid hormone, serum calcium, phosphorus and albumin levels measured before the study. Intravenous glucose tolerance test (TVGTT) after an overnight fast was performed to all patients. The Kt/V values of the patients in the study group were elevated to 1.5+0.02 by increasing the pump rate and the dialysis duration. The Kt/V values in the control group were tried to be kept constant (1.1+0.03). After 12 weeks, IVGTT was repeated in both groups. Glucose and insulin values were determined from all samples during IVGTT. Total areas under the curves of glucose and insulin values between 0 and 120 minutes were calculated by using the trapezoidal integration. Statistical analysis was performed with student's t-test, andnonparametric Mann-Whitney and Wilcoxon signed rank tests. After 12 weeks, while the fasting glucose levels of study group decreased from 91.8 ±4.8 mg/cll. to 73.5+2.4 mg/dl (p < 0.01), those of control group did not change significantly. The changes in the fasting insulin levels of both group were not significant. Stimulated glucose and insulin levels in the study group markedly decreased during IVGTT compared to the pre-study values. But those of control group did not change except the values between 2 and 60 minutes. After the study, the total area under the curves of glucose and insulin of study group significantly decreased when compared to the pre-study values. We suggested that there was a correlation between the increment in dialysis efficacy and insulin sensitivity due to the increase in metabolized glucose and decrease in insulin concentrations
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Abstract (Original Language): 
Bu çalışma, son dönem böbrek yetmezliği nedeniyle hemodiyaliz tedavisi gören 28 stabil hastada yapıldı. Tüm hastaların Kt/V değerleri ürekinetik model ile hesaplandı. 12 hafta boyunca Kt/V değerleri 1.0 'da tutulmaya çalışıldı. 12 hafta sonra ortalama Kt/V değeri 1.0±0.02 olan 18hasta çalışma grubu olarak seçildi. Ortalama Kt/ V değerleri 1.1 ±0.02 olan 10 hasta ise kontrol grubunu oluşturdular. Grupların yaş, diyaliz süreleri ve çalışma öncesi ölçülenparatiroidhormon, serum kalsiyum, fosfor ve albümin seviyeleri arasında fark yoktu. Tüm hastalara geceboyu süren açlık sonrası intravenöz glikoz tolerans testi (İVGTT) yapıldı. Çalışma grubundaki hastaların Kt/V değerleri pompa hızı ve diyaliz süresi artırılarak 1.5+0.02 'ye yükseltildi. Kontrol grubundaki hastaların Kt/ V değerleri sabit tutulmaya çalışıldı (l.l±0.03). 12 hafta sonra her iki grupta da İVGTT tekrarlandı. İVGTT sırasında elde edilen tüm örneklerden glikoz ve insülin düzeyleri çalışıldı. 0 ve 120 dakika arasındaki glikoz ve insülin değerleri için eğri altında kalan toplam alanlar hesaplandı. İstatistiksel analiz Student's t-test, nonparametrik Wilcoxon işaret ve Mann Whitney u-testi ile yapıldı. 12 hafta sonra, çalışma grubunun açlık serum glikoz seviyeleri 91.8±4.8 mg/dlden 73.5+2.4 mg/dl'ye azaldı (p<0.01), kontrol grubunda ise anlamlı bir değişiklik olmadı. Her iki grubun açlık insülin düzeylerindeki değişiklikler anlamlı değildi. Çalışma grubunda İVGTT sırasında elde edilen glikoz ve insülin değerleri çalışma öncesi değerler ile karşılaştırıldığında belirgin azaldılar. Ama, kontrol grubunda bu değerlerde 2. ve 60. dakikalar arası dışında çalışma sonrası anlamlı bir değişiklik olmadı. Çalışma sonrası, çalışma grubunda glikoz ve insülin eğrilerinin altında kalan toplam alanlar çalışma öncesi ile karşılaştırıldığında anlamlı azaldı. Biz, diyaliz etkinliğinin artırılması ile insülin duyarlılığı arasında bir korelasyon olduğunu, bununda metabolize olan glikoz miktarının artması ve insülin konsantrasyonlarının azalması ile ilişkili olduğunu düşündük.
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  • 4
229-235
  • Turkish

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