Insulin Resistance and Left Ventricular Mass in Non-Diabetic Hemodialysis Patients

AbstractBackgroundInsulin resistance (IR) is frequently recognized in patients with uremia, and it is thought that IR has a basic role in the pathogenesis of cardiovascular disease.ObjectiveTo evaluate the effect of IR on cardiovascular risk in non-diabetic patients receiving hemodialysis (HD).MethodsWe performed a cross-sectional observational study that comprised 186 non-diabetic patients receiving HD (95 men; mean [SD] age, 46.4 [10.8] years; age range, 35–60 years) who had been receiving HD for 7.3 (3.5) years. Demographic variables and laboratory values were recorded. Insulin resistance was determined using the Homeostatic Model Assessment (HOMA), and the left ventricular mass index (LVMI) was calculated via echocardiography.ResultsAccording to HOMA-IR levels, patients were categorized as having IR (HOMA-IR score ≥2.5; n = 53) or not having IR (HOMA-IR score <2.5; n = 133). Insulin resistance was determined in 28.4% of study patients. Compared with the non-IR group, the IR group had been receiving HD longer; had greater body mass index; and had higher serum creatinine, uric acid, triglyceride, insulin, and C-reactive protein concentrations, leukocyte count, and LVMI (P < 0.05). Patients with increased LVMI had significantly higher body mass index, systolic blood pressure, serum cholesterol and C-reactive protein concentrations, and HOMA score. At multivariate analysis, systolic blood pressure (β = 0.22; P = 0.03) and HOMA score (β = 0.26; P = 0.01) affected LVMI.ConclusionsInsulin resistance and hypertension are independent risk factors for left ventricular hypertrophy in non-diabetic patients with uremia who are receiving HD. Further studies are needed to indicate the benefits of improving IR for cardiovascular mortality in this subgroup of patients with uremia

Serum immone complexes in renal amyloidosis

Böbrek Hastalıkları ve Hipertansiyon VakfıAnkara Tıp Fakültesi Nefroloji Bilim Dalında, tanılan histolojik olarak konulmuş olan 32 renal amiloidozisli hasta ile 20 normal kişide serum immün kompleks değerleri ölçüldü. Serum immün kompleks değerleri amiloidozisli hastalarda normale göre belirgin olarak yüksek bulundu. Ayrıca primer, sekonder, ailevi akdeniz humması ve nedeni kesinlikle saptanamayan hastalar kendi aralarında karşılaştırıldı. Bu gruplar arasında, serum immün kompleks yoğunluğu açısından anlamlı bir farklılık bulunamadı.Serum immune complexes were measured in 32 patients with renal amyloidosis diagnosed histologically and 20 control subjects in the Section of Nephrology of Ankara Medical School. Serum immune complexe concentration in the patients with renal amyloidosis was higher than that normal subjects. There was no diagnostic value of serum immune complexes in the classification of the systemic amyloidosis