Insulin resistance in patients of end-stage renal disease (ESRD) on haemodialysis: Effect of short-term erythropoietin therapy

Abstract

Aim: Insulin resistance is a potentially modifiable cardiovascular risk factor and it can be considered as a therapeutic target in patients of chronic kidney disease (CKD), especially those undergoing haemodialysis. The present study was conducted to assess insulin resistance (IR) in patients of end-stage renal disease (ESRD) on haemodialysis and to evaluate effect of short-term treatment with recombinant human erythropoietin therapy. Material and methods: It was a prospective case control study which was carried out at a tertiary care hospital in North India, from May 2010 to September 2011. Adult patients of CKD (both diabetic and non-diabetic) were enrolled in the study and were randomly assigned into two groups. Study group consisted of 20 patients (10 diabetics and 10 non-diabetics) with ESRD who were on regular twice weekly haemodialysis and were given subcutaneous erythropoietin (80 to 120 U/kg/wk) after each session of dialysis. Control group included 10 patients with ESRD on regular haemodialysis but did not receive erythropoietin. Results: Mean baseline fasting insulin levels and insulin resistance as reflected by homeostasis model assesment of insulin resistance (HOMA-IR) were similar in the two groups. HOMA-IR was 5.48 ± 10.43 in the study group and 3.11 ± 2.16 in the control group.The levels decreased significantly to 0.51 ± 0.36 (P < 0.001) in the study group and increased insignificantly to 3.84 ± 4.08 (P >0.05) in the control group after 6 months. Conclusion: Fasting insulin level and insulin resistance is increased in CKD patients. Recombinant human erythropoietin therapy has a favourable effect on insulin sensitivity in addition to its role in the treatment of anaemia in cases of CKD on dialysis.