3 research outputs found
Correction of metabolic acidosis improves insulin resistance in chronic kidney disease Low protein diets and nutritional therapies in CKD: Investigating the current global trends Clinical Research
Background: Correction of metabolic acidosis (MA) with nutritional therapy or bicarbonate administration is widely used in chronic kidney disease (CKD) patients. However, it is unknown whether these interventions reduce insulin resistance (IR) in diabetic patients with CKD. We sought to evaluate the effect of MA correction on endogenous insulin action in diabetic type 2 (DM2) CKD patients. Methods: A total of 145 CKD subjects (83 men e 62 women) with DM2 treated with oral antidiabetic drugs were included in the study and followed up to 1 year. All patients were randomly assigned 1:1 to either open-label (A) oral bicarbonate to achieve serum bicarbonate levels of 24-28 mmol/L (treatment group) or (B) no treatment (control group). The Homeostatic model assessment (HOMA) index was used to evaluate IR at study inception and conclusion. Parametric and non-parametric tests as well as linear regression were used. Results: At baseline no differences in demographic and clinical characteristics between the two groups was observed. Average dose of bicarbonate in the treatment group was 0.7 ± 0.2 mmol/kg. Treated patients showed a better metabolic control as confirmed by lower insulin levels (13.4 ± 5.2 vs 19.9 ± 6.3; for treated and control subjects respectively; p < 0.001), Homa-IR (5.9[5.0-7.0] vs 6.3[5.3-8.2]; p = 0.01) and need for oral antidiabetic drugs. The serum bicarbonate and HOMA-IR relationship was non-linear and the largest HOMA-IR reduction was noted for serum bicarbonate levels between 24 and 28 mmol/l. Adjustment for confounders, suggests that serum bicarbonate rather than treatment drives the effect on HOMA-IR. Conclusions: Serum bicarbonate is related to IR and the largest HOMA-IR reduction is noted for serum bicarbonate between 24 and 28 mmol/l. Treatment with bicarbonate influences IR. However, changes in serum bicarbonate explains the effect of treatment on HOMA index. Future efforts are required to validate these results in diabetic and non-diabetic CKD patients
Cinacalcet but not vitamin D use modulates the survival benefit associated with sevelamer in the INDEPENDENT study
Aims: Whether differences
in outcomes of calcium-free vs. calciumcontaining
phosphate binder treatments can
be amplified by concurrent treatment with a
calcium-sensing receptor agonist or vitamin
D remains to be elucidated. Material and
methods: A post-hoc analysis of the INDEPENDENT
study, an open-label randomized
controlled trial designed to evaluate the
impact of sevelamer (SV) vs. calcium salts
(CS) on survival in incident dialysis patients.
Results: We recruited 466 middle-aged men
and women. Cinacalcet (CC) and vitamin D
(VD) were administered to a portion of patients
as part of their routine care. We tested
the impact of CC and VD on survival in the
overall and in both treatment arms of the
original study cohort. Overall SV, but not CC
or VD, administration was associated with
a survival benefit (mean follow-up: 28 (10)
months). However, a significant (p = 0.006)
interaction of SV and CC on mortality was
observed. CC use was associated with improved
survival if administered in combination
with SV (HR 0.34, 95% CI 0.14 – 0.81,
p = 0.01 for subjects receiving or not CC) but
not CS (HR 1.28, 95% CI 0.82 – 2.00; p =
0.26 for subjects receiving or not CC). No effect
on mortality or interaction of phosphate
binder use with VD was noted. Conclusions:
Though hypothesis generating, these results
lend support to the idea that use of a CC may
increase survival in incident hemodialysis
patients when used with a calcium-free phosphate
binder.
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