Insulin Receptor Defect in Diabetic Man With Chronic Renal Failure: A Comparison of Erythrocyte Insulin Binding in Diabetic and Nondiabetic Patients on Maintenance Hemodialysis

125I-Insulin binding to most accessible and easily obtained circulating erythrocytes in 7 diabetic and 16 nondiabetic, nonobese patients with chronic renal failure (CRF) on maintenance hemodialysis was studied and compared with that of the 30 normal, nonobese volunteers. The percent-age of 125I-insulin binding was 4.7 ± 1.8 (mean ± SD) in the diabetic and 13.1 ± 2.4 in the nondiabetic patients with CRF while in the normal subjects it was 9.9 ± 1.4. There was no statistical difference in the fasting levels of glucose, insulin, and glycosylated hemoglobins in all the subjects studied. No correlation (r = -0.32) between insulin binding and endogenous insulin was observed in these subjects. The diabetic patients with CRF had no circulating factor(s) that would reduce insulin binding to normal erythrocytes. In comparison to the normal subjects, the reduction in insulin binding in the diabetic patients with CRF was accompanied by 47% reduction in insulin receptor sites (R0) but with no change in insulin receptor affinity, ( K ̄e, 0.46 × 108m-1), while in the nondiabetic patients with CRF no change in insulin receptor sites (R0) of increased affinity ( K ̄e, 0.63 × 108m-1) was observed. These findings suggest that insulin binding utilizing the much simpler erythrocyte insulin receptor assay can be used to evaluate alteration in insulin receptor status in CRF. These investigations also provide a very useful assay and characteristic studies for insulin receptors, if receptor modulation acquires a status of treatment for diabetes