Intravenous calcitriol normalizes insulin sensitivity in uremic patients
| Autor: | Bernhard Ludvik, Giovanni Pacini, U. Barnas, Carola Streli, Alexandra Kautzky-Willer, Helmut Graf, Rudolf Prager |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
Blood Glucose Male medicine.medical_specialty Calcitriol medicine.medical_treatment Parathyroid hormone vitamin D deficiency Insulin resistance Renal Dialysis Internal medicine medicine Humans Pancreatic hormone Uremia Hyperparathyroidism business.industry Insulin Glucose Tolerance Test medicine.disease Glucose Endocrinology Parathyroid Hormone Nephrology Injections Intravenous Kidney Failure Chronic Female Hyperparathyroidism Secondary Secondary hyperparathyroidism Insulin Resistance business medicine.drug |
| Zdroj: | Kidney International. 47:200-206 |
| ISSN: | 0085-2538 |
| DOI: | 10.1038/ki.1995.24 |
| Popis: | Intravenous calcitriol normalizes insulin sensitivity in uremic patients. Recent studies suggest that secondary hyperparathyroidism and/or vitamin D deficiency are responsible for the insulin resistance in chronic renal failure. We investigated the effect of a 12-week intravenous treatment with 1,25 dihydroxycholecalciferol on glucose metabolism in 10 hemodialysis patients compared with 10 healthy control subjects by the frequently-sampled intravenous glucose tolerance test, analyzed with the minimal model technique. Compared to control subjects, the uremic patients featured elevated levels of parathyroid hormone (432 ± 60 vs. 41 ± 4 ng/liter, P < 0.001), insulin resistance (insulin sensitivity index, SI: 4.9 ± 0.8 vs. 9.5 ± 0.9 MIN-1/(µ/m1), P < 0.002), increased posthepatic insulin delivery (6.48 ± 2.48 vs. 2.73 ± 3.14 nmol/liter in 4 hr, P < 0.001) and a reduced C-peptide fractional clearance (0.033 ± 0.004 vs. 0.085 ± 0.009 min-1, P < 0.0002). Following treatment with 1,25 dihydroxycholecalciferol, the parathyroid hormone levels decreased significantly to 237 ± 30 ng/liter (P < 0.05), the insulin sensitivity index (SI: 9.6 ± 2.2, P < 0.05) reached a value similar to that of control subjects, and posthepatic insulin delivery decreased to 4.63 ± 0.83 nmol/liter in 4 hr (P < 0.01), while all the other parameters remained unchanged. In summary, uremic patients with secondary hyperparathyroidism were found to be severely insulin resistant and hyperinsulinemic. Intravenous vitamin D treatment led to a significant reduction of parathyroid hormone levels and to a complete normalization of insulin sensitivity in the hemodialysis patients. Thus, intravenous 1,25 dihydroxycholecalciferol improves insulin resistance in uremic patients, acting per se or by reducing secondary hyperparathyroidism. |
| Databáze: | OpenAIRE |
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