Screening of insulin resistance in patients with hemodialysis

Insulin resistance (IR) is defined as a violation of the biological response to stimulation of the heart, skeletal muscle, liver, and adipose tissue. The reasons for the formation of the syndrome are diverse, and clinical diagnosis is difficult since there is no generally accepted test available to determine it. For the diagnosis of IR directly and indirectly developed test groups. The complexity of their implementation in some cohorts of patients led to the development of a number of glycemic indices. However, no consensus has yet been reached on which one should be preferred. 

THE AIM: to compare IR screening methods in a cohort of hemodialysis patients. 

PATIENTS AND METHODS. 124 patients were examined, including 66 men and 58 women aged 57.6 ± 13.6 years, receiving HD treatment for 75.4 ± 44.5 months. For the screening of IR, the HOMA-1 and HOMA-2 glucose homeostasis model, QUICKI index, and triglycerides/glucose (TriH) were used. 

RESULTS. When conducting a nonparametric correlation analysis for fasting insulin plasma concentrations, statistically significant relationships were revealed only in men: with BMI (Rs = 0.258 p = 0.049), waist circumference to height ratio (Rs = 0.316 p = 0.015), and amount of dietary protein (Rs = 0.271 p = 0.039), systolic blood pressure (Rs = 0.308 p = 0.018), diastolic blood pressure (Rs = 0.290 p = 0.027), C-reactive protein level (Rs = 0.579 p = 0.0001). In women, no statistically significant correlations were found. The value of the Charlson index, as well as tobacco smoking, currently or in the history of the indicators of insulin resistance had no effect. According to the results of logistic regression analysis, the risk of developing clinical manifestations of atherosclerotic lesions of any vascular pool increased by 4.5 times (χ2 = 4.582 p = 0.032) with IR in the HOMA-1 model of more than 2.7 units, however, only in men. The relationship of other indicators of IR with atherosclerosis was not identified. 

CONCLUSION. A comparison of surrogate models of IR, from our point of view, allows us to distinguish HOMA-1 and HOMA-2. Probably, for the cross-sectional studies it is advisable to use the first of them, and for longitudinal – the second.

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