Effect of Insulin Infusion on insulin-like growth factor I (IGF-I) during Hemodialysis

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Background: Hemodialysis (HD) is a catabolic procedure probably contributing to the high frequency of protein-energy wasting among patients on maintenance HD. The aim was to investigate the effect of insulin infusion on insulin-like growth factor I (IGF-I) during HD compared with a meal alone. Methods: In a randomized cross-over study 11 non-diabetic HD patients (M/F:8/3, median age 57 years, range 33-79) received either 1) no treatment (NT), 2) glucose infusion (G) (10% glucose, 2.5 mL/kg/h), or 3) glucose-insulin infusion (GI) (10% glucose added 30 units of NovoRapid® per liter, 2.5 mL/kg/h) during a standardized 4 h HD. During infusion, blood glucose levels were maintained at 8.0-10.0 mmol/L by additional glucose infusion. Glucose and glucose-insulin infusions were commenced 2 h prior to HD and continued throughout the HD session. Fasting blood samples were collected at baseline before infusion and followed by the only meal allowed during the study. Results: Data are presented as mean±SD. From baseline to end of HD session we observed an overall increase in both serum bioactive IGF-I (from 0.83±0.27 to 1.01±0.34 µg/L, p<0.001) and in total IGF-I (from 124±43 to 132±52 µg/L, p=0.001), but no significant difference in the change in either serum bioactive IGF-I (p=0.99) or total IGF-I (p=0.22) between the groups. Concomitantly, there was an overall decrease in serum IGF-binding protein 1 (IGFBP-1) (from 267±147 to 143±92 µg/L, p<0.001) from baseline to end of HD, but no significant difference in the change between the groups (p=0.43). Conclusion: A meal at the beginning of a HD session leads to an increase in bioactive IGF-I thereby assumingly counteracting the catabolic effects of HD. However, according to changes in bioactive IGF-I neither glucose nor glucose-insulin infusion during HD appear to add to the anabolic effects of a meal.
Udgivelsesår28 apr. 2012
StatusUdgivet - 28 apr. 2012

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