Insulin kinetics and glucose-induced insulin delivery in chronically dialyzed subjects: acute effects of dialysis.

Disordered insulin metabolism and production are known features of uremia, but their relation to the glucose intolerance and insulin resistance associated with this condition has been the subject of controversy. We investigated the kinetics of plasma insulin in eight subjects on maintenance hemodialysis for 10 ± 4 (mean ± SEM) months, using [125I]insulin as a tracer for the native hormone and noncompartmental analysis of the isotopic data. A standard glucose challenge (iv glucose tolerance test) was then given, and insulin response was quantified by deconvolution. To assess the acute effects of dialysis, each uremic subject was studied first 65–109 and then 7–22 h from the last dialysis. Insulin MCR was slightly depressed before dialysis (365 ± 48 ml/min · m2) compared with a control group of 17 healthy subjects (465 ± 22) and rose significantly (P < 0.05) after dialysis (462 ± 60). Mean residence time (69.4 ± 11.7 min) and total distribution volume (21.9 ± 2.1 liters/m2) were bothmuch greater (P < 0.001)...