Insulin Hypersecretion in Patients on Chronic Hemodialysis. Role of Parathyroids

Abstract

Plasma insulin levels following the administration of intravenous glucose were studied in patients with chronic renal failure treated by a Giovannetti diet, or by regular hemodialysis. The plasma insulin response in the diet-treated patients was significantly reduced when compared with the response of normal controls but was generally increased in patients treated by hemodialysis. The insulin response of dialyzed patients without severe hyperparathyroidism was not significantly higher than normal controls. The insulin response was significantly increased in dialyzed patients with severe secondary hyperparathyroidism and in one patient with primary hyperparathyroidism. After parathyroidectomy the early insulin response returned to normal levels in both primary and secondary hyperparathyroidism. Impaired glucose tolerance, as shown by a low glucose decay constant (Kg value), was present in the uremic, diettreated patients. There was no evidence of impaired carbohydrate tolerance in the dialyzed patients, irrespective of the parathyroid status.