Background: Although various modalities of hemodialysis (HD) are presumed to have different effects on insulin resistance (IR), the relationship between hemodiafiltration (HDF) and IR has not been fully evaluated. Methods: In a cross-sectional study, 82 non-diabetic HD patients were enrolled. The patients were divided into two groups according to the median homeostasis model assessment index (HOMA-IR) value of 1.685. Clinical and biochemical data were compared, and multivariate logistic regression analysis was performed to identify the independent factors associated with higher HOMA-IR. Results: The higher HOMA-IR group had increased body mass index (BMI), decreased HDL cholesterol, and lower beta-2 microglobulin reduction rate (β2-MG RR) compared to the lower HOMA-IR group. HOMA-IR was significantly correlated with β2-MG RR. In addition, HDF patients had lower HOMA-IR levels compared with low flux hemodialysis patients. On multivariate logistic regression analysis, BMI and HDF treatment were independent factors associated with higher and lower HOMA-IR, respectively. Conclusion: This study suggests that HDF treatment may reduce IR in non-diabetic HD patients.

1.
Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St Peter W, Guo H, Gustafson S, Li Q, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: US Renal Data System 2010 Annual Data Report. Am J Kidney Dis 2011;57:A8,e1-e526.
2.
DeFronzo RA, Alvestrand A, Smith D, Hendler R, Hendler E, Wahren J: Insulin resistance in uremia. J Clin Invest 1981;67:563-568.
3.
Kobayashi S, Maesato K, Moriya H, Ohtake T, Ikeda T: Insulin resistance in patients with chronic kidney disease. Am J Kidney Dis 2005;45:275-280.
4.
Bressler P, Bailey SR, Matsuda M, DeFronzo RA: Insulin resistance and coronary artery disease. Diabetologia 1996;39:1345-1350.
5.
Laakso M, Sarlund H, Salonen R, Suhonen M, Pyörälä K, Salonen JT, Karhapää P: Asymptomatic atherosclerosis and insulin resistance. Arterioscler Thromb 1991;11:1068-1076.
6.
Shinohara K, Shoji T, Emoto M, Tahara H, Koyama H, Ishimura E, Miki T, Tabata T, Nishizawa Y: Insulin resistance as an independent predictor of cardiovascular mortality in patients with end-stage renal disease. J Am Soc Nephrol 2002;13:1894-1900.
7.
Ausk KJ, Boyko EJ, Ioannou GN: Insulin resistance predicts mortality in nondiabetic individuals in the U.S. Diabetes Care 2010;33:1179-1185.
8.
Hung AM, Ikizler TA: Factors determining insulin resistance in chronic hemodialysis patients. Contrib Nephrol 2011;171:127-134.
9.
Tattersall JE, Ward RA; EUDIAL group: Online haemodiafiltration: definition, dose quantification and safety revisited. Nephrol Dial Transplant 2013;28:542-550.
10.
Maduell F, Navarro V, Cruz MC, Torregrosa E, Garcia D, Simon V, Ferrero JA: Osteocalcin and myoglobin removal in online hemodiafiltration versus low- and high-flux hemodialysis. Am J Kidney Dis 2002;40:582-589.
11.
Ohtake T, Oka M, Ishioka K, Honda K, Mochida Y, Maesato K, Moriya H, Hidaka S, Kobayashi S: Cardiovascular protective effects of on-line hemodiafiltration: comparison with conventional hemodialysis. Ther Apher Dial 2012;16:181-188.
12.
Gracia-Iguacel C, Gallar P, Qureshi AR, Ortega O, Mon C, Ortiz M, Villarreal I, Garcia-Lacalle C, Olieta A, Sánchez M, Herrero JC, Vigil A, Lindholm B, Carrero JJ: Vitamin D deficiency in dialysis patients: effect of dialysis modality and implications on outcome. J Ren Nutr 2010;20:359-367.
13.
Melero-Rubio E, Párraga-Díaz M, Gómez-Sánchez MP, Pellicer-Villaescusa S, Merchán-Mayado E: Observational study on markers of cardiovascular risk in renal patient: conventional hemodialysis versus haemofiltration online. J Ren Care 2009;35:201-204.
14.
Raikou VD, Tentolouris N, Kyriaki D, Evaggelatou A, Tzanatou H: β2-Microglobulin, pulse pressure and metabolic alterations in hemodialysis patients. Nephron Clin Pract 2011;117:c237-c245.
15.
Mak RH: Insulin resistance in uremia: effect of dialysis modality. Pediatr Res 1996;40:304-308.
16.
Oshida Y, Sato Y, Shiraishi S, Sakamoto N: Studies on glucose intolerance in chronic renal failure: estimation of insulin sensitivity before and after initiation of hemodialysis. Clin Nephrol 1987;28:35-38.
17.
Shoelson SE, Lee J, Goldfine AB: Inflammation and insulin resistance. J Clin Invest 2006;116:1793-1801.
18.
Guth HJ, Gruska S, Kraatz G: On-line production of ultrapure substitution fluid reduces TNF-alpha- and IL-6 release in patients on hemodiafiltration therapy. Int J Artif Organs 2003;26:181-187.
19.
Herrera-Gutiérrez ME, Seller-Pérez G, Arias-Verdú D, Granados MM, Dominguez JM, Navarrete R, Morgaz J, Gómez-Villamandos R: A comparison of the effect of convection against diffusion in hemodynamics and cytokines clearance in an experimental model of septic shock. J Trauma Acute Care Surg 2012;73:855-860.
20.
Filiopoulos V, Hadjiyannakos D, Metaxaki P, Sideris V, Takouli L, Anogiati A, Vlassopoulos D: Inflammation and oxidative stress in patients on hemodiafiltration. Am J Nephrol 2008;28:949-957.
21.
Lai MH: Antioxidant effects and insulin resistance improvement of chromium combined with vitamin C and E supplementation for type 2 diabetes mellitus. J Clin Biochem Nutr 2008;43:191-198.
22.
Vaslaki L, Major L, Berta K, Karatson A, Misz M, Pethoe F, Ladanyi E, Fodor B, Stein G, Pischetsrieder M, Zima T, Wojke R, Gauly A, Passlick-Deetjen J: On-line haemodiafiltration versus haemodialysis: stable haematocrit with less erythropoietin and improvement of other relevant blood parameters. Blood Purif 2006;24:163-173.
23.
Akoglu H, Dede F, Piskinpasa S, Falay MY, Odabas AR: Impact of low- or high-flux haemodialysis and online haemodiafiltration on inflammatory markers and lipid profile in chronic haemodialysis patients. Blood Purif 2013;35:258-264.
24.
Mandolfo S, Borlandelli S, Imbasciati E: Leptin and beta2-microglobulin kinetics with three different dialysis modalities. Int J Artif Organs 2006;29:949-955.
25.
Silva MI, Lemos CC, Torres MR, Bregman R: Waist-to-height ratio: an accurate anthropometric index of abdominal adiposity and a predictor of high HOMA-IR values in nondialyzed chronic kidney disease patients. Nutrition 2014;30:279-285.
26.
Qu H, Li Q, Rentfro AR, Fisher-Hoch SP, McCormick JB: The definition of insulin resistance using HOMA-IR for Americans of Mexican descent using machine learning. PLoS One 2011;6:e21041.
27.
de Moraes TP, Fortes PC, Ribeiro SC, Riella MC, Pecoits-Filho R: Comparative analysis of lipid and glucose metabolism biomarkers in non-diabetic hemodialysis and peritoneal dialysis patients. J Bras Nefrol 2011;33:173-179.
28.
Nikolopoulou A, Kadoglou NP: Obesity and metabolic syndrome as related to cardiovascular disease. Expert Rev Cardiovasc Ther 2012;10:933-939.
29.
Grundy SM: Metabolic syndrome: a multiplex cardiovascular risk factor. J Clin Endocrinol Metab 2007;92:399-404.
30.
Canaud B, Bragg-Gresham JL, Marshall MR, Desmeules S, Gillespie BW, Depner T, Klassen P, Port FK: Mortality risk for patients receiving hemodiafiltration versus hemodialysis: European results from the DOPPS. Kidney Int 2006;69:2087-2093.
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