THE EFFECT OF INCREASED KT/V VALUES ON INSULIN RESISTANCE IN THE HEMODIALYSIS PATIENTS

28 outpatients with end-stage renal disease who were on hemodialysis treatment were included in the study. Kt/V values of all cases were calculated by ureakinetic modelling. During 12 weeks we tried to keep Kt/V almost equal to 1.0 in all patients. After 12 weeks 18 cases who had mean Kt/V value of 1.0+0.02 were selected as the study group. 10 cases with the mean Kt/V value of 1.1+0.02 were selected as control group. The mean age of study and control groups was 36.5+1.0 years and 37.2+1.5 years, respectively. Among groups, there was no difference in terms of age, the duration of dialysis, parathyroid hormone, serum calcium, phosphorus and albumin levels measured before the study. Intravenous glucose tolerance test (TVGTT) after an overnight fast was performed to all patients. The Kt/V values of the patients in the study group were elevated to 1.5+0.02 by increasing the pump rate and the dialysis duration. The Kt/V values in the control group were tried to be kept constant (1.1+0.03). After 12 weeks, IVGTT was repeated in both groups. Glucose and insulin values were determined from all samples during IVGTT. Total areas under the curves of glucose and insulin values between 0 and 120 minutes were calculated by using the trapezoidal integration. Statistical analysis was performed with student's t-test, and nonparametric Mann-Whitney and Wilcoxon signed rank tests. After 12 weeks, while the fasting glucose levels of study group decreased from 91.8 ±4.8 mg/cll. to 73.5+2.4 mg/dl (p < 0.01), those of control group did not change significantly. The changes in the fasting insulin levels of both group were not significant. Stimulated glucose and insulin levels in the study group markedly decreased during IVGTT compared to the pre-study values. But those of control group did not change except the values between 2 and 60 minutes. After the study, the total area under the curves of glucose and insulin of study group significantly decreased when compared to the pre-study values. We suggested that there was a correlation between the increment in dialysis efficacy and insulin sensitivity due to the increase in metabolized glucose and decrease in insulin concentrations.