| [ Summary ] |
Despite the existence of insulin resistance in almost all patients with ESRD, only about 50 % of these patients demonstrate glucose intolerance and hyperglycemia. Others maintain normoglycemia at the expense of developing hyperinsulinemia. This is due to variations in insulin secretory responses with hyperglycemia. Some patients with hyperparathyroidism and / or vitamin D deficiency are reported to have insulin secretory abnormalities. There is also evidence that poor physical fitness, anemia, uremic toxins and hyper-cytokinemia may be factors contributing to insulin resistance in patients with ESRD. Furthermore, MIA (malnutrition, inflammation, atherosclerosis) syndrome may accelerate insulin resistance in patients with ESRD. |