Association of hypertriglyceridemia and insulin resistance in uremic patients undergoing CAPD
Journal
Peritoneal Dialysis International
Journal Volume
21
Journal Issue
3
Pages
282-289
Date Issued
2001
Author(s)
Abstract
◆ Objective: Hyperlipidemia is frequently encountered in uremic patients and may be worsened by continuous ambulatory peritoneal dialysis (CAPD) treatment. The lipid abnormalities in these patients may be multifactorial. Insulin resistance (or its compensatory hyperinsulinemia) is commonly observed in uremic patients, but its association with hyperlipidemia in these patients has not been studied. ◆ Patients and Methods: Lipid profiles of 35 nondiabetic nonobese patients undergoing CAPD for more than 1 year (mean 52.3 months) were studied. Current laboratory data and parameters related to peritoneal dialysis (PD) within the previous 3 months were recorded. After overnight fasting and interruption of PD, an oral 75-g glucose tolerance test (OGTT) was examined. ◆ Results: After CAPD treatment for more than 12 months, these patients had higher serum triglyceride (TG) (p = 0.001) and total cholesterol (p = 0.0058) levels than their values before commencing CAPD. Twelve of 14 patients with serum TG higher than 200 mg/dL (high-TG) were diagnosed de novo, in contrast with only 1 patient diagnosed of de novo hypercholesterolemia (total cholesterol > 240 mg/dL). There was no difference in age, gender, body mass index (BMI), duration of PD treatment, serum albumin, hematocrit, intact serum parathyroid hormone (iPTH), peritoneal glucose load, solute transport, or weekly Kt/V urea between normal-TG and high-TG patients. After adjusting for age, gender, BMI, weekly Kt/V urea, and iPTH, the high-TG patients had higher levels of area under the curve for glucose (AUCGlu), area under the curve for insulin (AUCIns), and AUCIns/AUCGlu ratios (F=10.63, 10.14, and 8.65; p = 0.0029, 0.0035, and 0.0065, respectively), indicating that the high-TG patients were more insulin resistant. There were 24 patients with normal glucose tolerance (NGT), and 11 patients with impaired glucose tolerance (IGT). The IGT group had higher serum TG (F = 10.43, p = 0.003) and total cholesterol (F = 8.05, p = 0.009) than the NGT group, after adjusting for BMI, duration of CAPD treatment, peritoneal glucose load, solute transport, serum albumin, and lipid levels before PD treatment. The TG levels after CAPD treatment were positively correlated with AUCGlu, AUCIns, and AUCIns/AUCGlu ratio (r = 0.48, 0.53, and 0.49; p = 0.0037, 0.001, and 0.0028, respectively). ◆ Conclusions: These results indicate that insulin resistance is an important factor in the development of hypertriglyceridemia in CAPD patients.
SDGs
Other Subjects
albumin; beta adrenergic receptor blocking agent; cholesterol; gemfibrozil; parathyroid hormone; simvastatin; triacylglycerol; adult; age; aged; albumin blood level; area under the curve; article; body mass; cholesterol blood level; clinical article; continuous ambulatory peritoneal dialysis; controlled study; correlation function; disease association; female; gender; hematocrit; human; hypercholesterolemia; hyperinsulinemia; hyperlipidemia; hypertension; hypertriglyceridemia; impaired glucose tolerance; insulin resistance; laboratory test; male; oral glucose tolerance test; parameter; parathyroid hormone blood level; priority journal; recording; triacylglycerol blood level; uremia
Publisher
Multimed Inc.
Type
journal article