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Effect of Hematodialysis plus Hemoperfusion on Insulin Resistance and Nutritional Status of Patients with End-Stage Diabetic Nephropathy

time :  2017-07-19

Antony Raine, Daniel Cordonnier*, Eberhard Ritz

Section of Nephrology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA


Objective: To explore the effect of hematodialysis (HD) combined with hemoperfusion (HP) on the insulin resistance (IR) and nutritional status of patients with end-stage diabetic nephropathy(ESDN).

Methods: Eighty-six patients with ESDN were randomly divided into group A (n=28), group B (n=30) and group C (n=28), and another 24 healthy volunteers were selected as control group. Groups A, B and C were respectively treated with routine HD, HD combined with hemodiafiltration (HDF) as well as and HD combined with HP. The levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) as well as the changes of urea nitrogen (BUN), creatinine (Scr), fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (Homa-IR), hemoglobin (Hb), albumin (Alb) and body mass index (BMI) were compared among groups before and 12 weeks after treatment.

Results: 12 weeks after treatment, the levels of CRP, TNF-α and IL-6 in group A did not change obviously, whereas those in groups B and C decreased dramatically when compared with treatment before (P<0.05 or P<0.01), in which the decreased range in group C was the most significant, but it was still higher than in control group (P<0.01). 12="" there="" was="" no="" statistical="" significance="" among="" three="" groups="" with="" regard="" to="" the="" levels="" of="" bun="" and="" scr="" before="" weeks="" after="" treatment="" p="">0.05). Compared with treatment before, FBG and FINS levels as well as Homa-IR reduced (P<0.05 or P<0.01), Hb, Alb and BMI elevated markedly in group C 12 weeks after treatment (P<0.01), while="" those="" in="" groups="" a="" and="" b="" did="" not="" change="" conspicuously="" p="">0.05). FBG, FINS and Homa-IR were all lower, but Hb, Alb and BMI were markedly higher in group C than in groups A and B 12 weeks after treatment, and significant differences were shown (P<0.05 or P<0.01).

Conclusion: HD combined with HP can effectively remove the mid- and macro molecular inflammatory mediators alleviate IR and ameliorate the nutritional status to reduce the incidence of malnutrition in the patients with ESDN.

Key words: Hematodialysis, Hemoperfusion, End-stage diabetic nephropathy, Insulin resistance, Nutritional status

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