Insulin resistance in patients with end-stage renal disease on hemodialysis: effect of short-term erythropoietin therapy

Abstract

Background Insulin resistance (IR) is a characteristic feature of uremia. Both IR and metabolic syndrome are considered independent predictors for cardiovascular events and mortality in patients with chronic kidney disease. Few studies have shown a favorable effect of erythropoietin (EPO) in decreasing IR. We hypothesized that short-term treatment with EPO can lead to improvement of IR in patients with chronic kidney disease. Patients and methods Patients were categorized into two groups: 20 hemodialysis patients (HDP) not receiving EPO (control) compared with other 40 HDP divided into two subgroups (20 diabetics and 20 nondiabetic), both receiving EPO (intervention group) all over the duration of the study, which extended for 6 months. All patients were subjected to history taking, full clinical examination, as well as laboratory investigations. Results All baseline results of parameters of glycemic control showed significant stepwise increase from nondiabetic intervention group, to control group, and then to diabetic intervention group. homeostatic model assessment of insulin resistance (HOMA-IR) was 1.64±0.88, 6.14±0.46, and then 10.78±2.84, respectively. On comparing the results before and after EPO therapy in both intervention groups, there was a significant improvement in IR in both groups. HOMA-IR was 10.78±2.84 and 5.52±161 (P<0.001) before and after intervention, respectively, for diabetic patients, whereas it was 1.64±0.88 and 0.8±0.28 (P<0.001) before and after intervention, respectively, for nondiabetic patients. Glycated hemoglobin, fasting insulin level, as well as fasting and postprandial glucose measurements, all in both preintervension and postintervention settings were independent predictors for HOMA-IR after intervention in all 40 patients of both intervention groups. Conclusion EPO treatment in HDPs is followed by improvement of IR in diabetic as well as nondiabetic patients with end-stage kidney disease and on hemodialysis.