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Insulin resistance and glucose homeostasis in peritoneal dialysis.
Perit Dial Int. 2009 Feb; 29 Suppl 2:S145-8.PD

Abstract

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.

Authors+Show Affiliations

Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19270204

Citation

Fortes, Paulo Cezar, et al. "Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 29 Suppl 2, 2009, pp. S145-8.
Fortes PC, de Moraes TP, Mendes JG, et al. Insulin resistance and glucose homeostasis in peritoneal dialysis. Perit Dial Int. 2009;29 Suppl 2:S145-8.
Fortes, P. C., de Moraes, T. P., Mendes, J. G., Stinghen, A. E., Ribeiro, S. C., & Pecoits-Filho, R. (2009). Insulin resistance and glucose homeostasis in peritoneal dialysis. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 29 Suppl 2, S145-8.
Fortes PC, et al. Insulin Resistance and Glucose Homeostasis in Peritoneal Dialysis. Perit Dial Int. 2009;29 Suppl 2:S145-8. PubMed PMID: 19270204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Insulin resistance and glucose homeostasis in peritoneal dialysis. AU - Fortes,Paulo Cezar, AU - de Moraes,Thyago Proença, AU - Mendes,Jamille Godoy, AU - Stinghen,Andrea E, AU - Ribeiro,Silvia Carreira, AU - Pecoits-Filho,Roberto, PY - 2009/3/10/entrez PY - 2009/5/16/pubmed PY - 2009/6/20/medline SP - S145 EP - 8 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 29 Suppl 2 N2 - 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. SN - 0896-8608 UR - https://www.unboundmedicine.com/medline/citation/19270204/Insulin_resistance_and_glucose_homeostasis_in_peritoneal_dialysis_ L2 - https://medlineplus.gov/kidneyfailure.html DB - PRIME DP - Unbound Medicine ER -