The Effect of Dialysis on the Carbohydrate Intolerance of Chronic Renal Failure

Abstract

Oral glucose tolerance tests were performed in relation to hemodialysis and peritoneal dialysis. The results have shown lower fasting blood sugars and considerably improved glucose tolerance in the immediate post-dialysis period. Both basal serum insulin levels and the rise following glucose were enhanced after hemodialysis. On the other hand, peritoneal dialysis resulted in lower insulin levels. Although there were no consistent changes in the elevated growth hormone concentrations after either dialysis, higher levels were more frequently observed in patients undergoing peritoneal dialysis. In all subjects, plasma-free fatty acids supressed promptly after glucose administration. Following hemodialysis, there was a greater fall in blood sugar in response to tolbutamide, but his was not associated with an enhanced insulin response. Progressive improvement in glucose tolerance occurred in one subject tested serially after renal transplantation. The causes and significance of these metabolic abnormalities in uremic patients are discussed. 1 Supported by a grant from the South African Sugar Industry and the Fisher Endocrine Research Fund