Effect of short-term rHuEPO treatment on insulin resistance in haemodialysis patients

Background/Aim: Decreased sensitivity to the hypoglycaemic action of insuli n is an almost universal phenomenon in uraemic patients, and it is attribut ed either to uraemic toxins or to anaemia or even to secondary hyperparathy roidism. Considering the conflicting data of few existing studies, we exami ned the influence of erythropoietin (EPO) treatment on insulin resistance a nd tested the probable correlation of this influence with sympathetic nervo us system (SNS) activity. Methods: We studied 8 non-obese, non-diabetic, st able dialysis patients using the euglycaemic insulin clamp technique before administration of EPO (phase A), 10 days after (phase B), and after the co rrection of the haematocrit level, at least 8 weeks later (phase C). We est imated the indices (glucose infusion rate, mg/kg/min), M/G (glucose clearan ce), and M/I (tissue sensitivity to insulin), and we measured haematocrit, haemoglobin, triglyceride, ferritin, EPO, and fasting insulin levels in eac h phase. During each phase, we tested the SNS activity using the response o f blood pressure to persistent handgrip and the response of blood pressure to the standing position. Results: Our patients appeared to have an increas ed insulin resistance in phase A (M-A = 6.24 +/- 1.01) which was significan tly improved 10 days after the beginning of EPO treatment and before the ri se of haematocrit (M-B = 7.71 +/- 1.54, p < 0.05). There was no further imp rovement in phase C. Indices M/G and M/I behaved similarly. The serum trigl yceride levels decreased in response to the increased insulin sensitivity. The patients studied did not demonstrate fasting hyperinsulinaemia, while t he SNS activity was abnormal and remained unchanged throughout the study pe riod in spite of some individual improvement. Conclusions: Our study proves the beneficial effect of EPO treatment on insulin resistance in dialysis p atients which could be attributed to the EPO itself and not to the correcti on of anaemia and is accompanied by improvement in triglyceride levels. Ame lioration of insulin resistance did not influence the SNS activity, making the association between EPO treatment and SNS-derived changes in blood pres sure quite improbable. Copyright (C) 2000 S. Karger AG. Basel.