Is insulin an independent predictor of mortality in hemodialysis patients?
Reduced insulin sensitivity is present in patients with end-stage renal failure (ERF). It has been established in general population that insulin resistance is a cardiovascular risk factor. The present study examines the potential effect of insulin action and secretion on over-all and cardiovascular mortality in non-diabetic haemodialysis (HD) patients. Sixty two patents (age 52.5 ? 10.3 year) on maintenance haemodialysis (5.4 ? 3.1 year) were recruited in June, 1994 and were followed-up over a 5-year period. At the end of the study we had two those who survived and those who died: survivals and deaths. All basic clinical indicators (age, gender, duration of dialysis prior to entry into the study, blood pressure, serum proteins, albumins, lipids and lipoproteins, urea, creatinine, dialysis dose defined by Kt/V, protein catabolic rate-nPCR, glucose, insulin, C peptide, IR-HOMA and % b- HOMA) were screened for a significant relation to outcome by univariante logistic regression models. Multiple logistic regression analysis was used to evaluate potentional independent predictors of death. Patients of both groups, survivals (n=42) and deaths (n=20), had a comparable duration of HD before the study, and as to blood pressure, serum proteins, albumines, lipids and lipoproteins A and B 100, lipoprotein (a), glucose, glycosylated haemoglobin, and Kt/V there were no significant differences. Patients who died were significantly older, and they had lower values of urea, creatinine, insulin, C-peptide and nPCR. Multiple logistic regression analysis indicated that only insulin and nPCR were significantly and independently associated with all-cause mortality and cardiovascular mortality, and age was an important confounding factor. These results suggest that we need an early procedure to preserve beta-cell function, besides positive nitrogen balance, to reduce cardiovascular and over-all mortality in haemodialysis patients.