Endocrine Abstracts

Insulin resistance is an integral part of the metabolic syndrome. Insulin resistance and metabolic syndrome predisposes to chronic kidney disease. However, the determinants of insulin resistance (measured by the homeostasis model, HOMA-IR) and metabolic syndrome are not known in hemodialysis (HD) patients. Thus, we studied 157 HD patients.

Results: The prevalence of metabolic syndrome was 46.5%. Patients with metabolic syndrome had higher HOMA-IR (5.6±1 vs. 1.8±0.3, P<0.001), interdialytic weight gain (3.3±0.2 vs. 3±0.1 kg, P<0.05) and intradialytic DBP drop (12±1 vs. 7±1 mmHg, P<0.05) and lower Kt/V (1.5±0.03 vs. 1.54±0.02, P<0.05), serum creatinine (9.9±0.3 vs. 10.4±0.2 mg/dl, P<0.05). The determinants of metabolic syndrome were: female, diabetes, HOMA-IR, cholesterol, interdialytic weight gain, magnesium and low Kt/V. The risk of metabolic syndrome reached a plateau when HOMA-IR≥1.0. The risk of metabolic syndrome was U-shaped with the nadir of magnesium at 2.4 mg/dl. The risk of metabolic syndrome was also U-shaped with the nadir of Kt/V at 1.7. The determinants of HOMA-IR were: age, short duration of HD, HBsAg, triglyceride, low HDL-cholesterol, uric acid, ferritin, intradialytic drop in SBP and low PTH.

Conclusion: The prevalence of metabolic syndrome was much higher in HD patients than the general population (46.5% vs. 11.6%). The determinants of metabolic syndrome and HOMA-IR were different. Therefore, metabolic syndrome and insulin resistance are similar but distinct entities.