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Perit Dial Int 29(Supplement_2): 145-148
2009
© 2009 International Society for Peritoneal Dialysis
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Part 4: Metabolic Syndrome and Nutrition in PD

INSULIN RESISTANCE AND GLUCOSE HOMEOSTASIS IN PERITONEAL DIALYSIS

Paulo Cezar Fortes, Thyago Proença de Moraes, Jamille Godoy Mendes, Andrea E. Stinghen, Silvia Carreira Ribeiro and Roberto Pecoits-Filho

Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil

Correspondence to: R. Pecoits–Filho, Center for Health and Biological Sciences, Imaculada Conceição, 1155, Curitiba PR 80215-901 Brazil. r.pecoits{at}pucpr.br

Cardiovascular disease (CVD) is the main cause of death in peritoneal dialysis (PD) patients, a situation that can be explained by a combination of traditional and nontraditional risk factors for CVD in these patients. Glucose and insulin homeostasis are altered in chronic kidney disease (CKD) patients even in the early stages of CKD, leading to insulin resistance by various pathways. Several factors have been implicated in the pathogenesis of insulin resistance, including anemia, dyslipidemia, uremia, malnutrition, excess of parathyroid hormone, vitamin D deficiency, metabolic acidosis, and increase in plasma free fatty acids and proinflammatory cytokines. Insulin resistance and dyslipidemia are observed and increase with the progression of CKD, playing an important role in the pathogenesis of hypertension and atherosclerosis. Particularly in PD patients, exposure to glucose from dialysis fluid accentuates the foregoing metabolic abnormalities. In conclusion, insulin resistance and altered glucose metabolism are frequently observed in CKD, and although dialysis partly corrects those disturbances, the use of glucose PD solutions intensifies a series of harmful metabolic consequences. New therapeutic measures aimed at reducing metabolic disorders are urgently needed and perhaps will improve PD patient survival.

KEY WORDS: Chronic kidney disease; insulin resistance.






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