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Anti‐inflammatory effect of an insulin infusion in patients on maintenance haemodialysis: A randomized controlled pilot study
Author(s) -
VOS FREDERIEK E,
MANNING PATRICK J,
SUTHERLAND WAYNE HF,
SCHOLLUM JOHN B,
WALKER ROBERT J
Publication year - 2011
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2010.01329.x
Subject(s) - medicine , insulin , dialysis , hemodialysis , neopterin , c reactive protein , uremia , endocrinology , gastroenterology , inflammation
Aim: A pilot study to investigate the anti‐inflammatory effect of insulin in patients on maintenance haemodialysis. Background: Elevated concentrations of pro‐inflammatory and oxidative mediators are thought to contribute to the increased cardiovascular risk in haemodialysis. Insulin has been demonstrated to have anti‐inflammatory properties and a continuous low‐dose insulin infusion in critically ill patients is associated with improved outcomes. The anti‐inflammatory effects of insulin in haemodialysis have not been investigated. Methods: In a single‐blind cross‐over study, 11 stable, non‐diabetic, haemodialysis patients received a continuous insulin infusion (Actrapid 2 IU/h) during a dialysis of 4 h or a conventional dialysis in random order. Normoglycaemia was maintained by a modified glucose dialysate and glucose infusion. Blood samples were collected at baseline, 1, 4, 6 and 24 h. C‐reactive protein (CRP), tumour necrosis factor‐α, interleukin‐6, neopterin, vascular cell adhesion molecule 1, protein thiols, dityrosine and peroxides were measured. Results: Insulin produced a significant reduction in median CRP over the immediate dialysis phase (confidence interval) by 6% (2–9% (95% CI), P = 0.006) and an even greater decline at 24 h (19% (8–28%, 95% CI), P = 0.001) compared with values of the conventional dialysis. No significant changes were observed in the other markers. Median glucose levels were comparable during both dialysis sessions. Conclusions: During haemodialysis, insulin may have a modest anti‐inflammatory effect as evident by a reduction in CRP that appears to have a persistent effect over the next 24 h post dialysis. More studies are required to examine longer‐term benefits as well as the potential role in more high‐risk individuals.