Plasma insulin is removed by hemodialysis: evaluation of the relation between plasma insulin and glucose by using a dialysate with or without glucose.

The aim of the present study was to evaluate the alteration in plasma immunoreactive insulin (IRI) and glucose concentrations due to hemodialysis (HD) treatment by using a dialysate with or without glucose in HD patients. We divided the patients into three groups: non-diabetic patients (n-DM group), well-controlled diabetic patients (HbA(1c) <7.0% [w-DM group]), and poorly-controlled diabetic patients (HbA(1c) > or = 7.0% [p-DM group]). Using a dialysate with a glucose concentration of 100 mg/dL (glu(+)-dialysate) and a glucose-free dialysate (glu(-)-dialysate), we studied the daily profiles of plasma glucose in the three groups. We measured the levels of plasma glucose and IRI at three time points (predialysis and 2 h and 4 h after the initiation of dialysis) at pre(A) and postdialyzer (V) sites in HD patients. There was a significant increase in the daily profiles of the plasma glucose level from the time before dinner until bedtime in both the w-DM and p-DM groups, when comparing the values on an HD day with those on a non-HD day. In the p-DM group, the use of the glu(-)-dialysate resulted in a significant hyperglycemia in the evening hours when compared with the use of the glu(+)-dialysate. In the DM group, the use of the glu(+)-dialysate resulted in a significant decrease in the plasma glucose and IRI levels during HD. However, in the n-DM group, there was no difference in the plasma glucose levels during HD. On the other hand, the use of a glucose-free dialysate led to a significant decrease in the plasma glucose and IRI levels during HD in all groups. The plasma IRI levels decreased significantly between the A and V sites at each point in all groups irrespective of the glucose concentration of the dialysate. The present study confirmed that the concentration of not only glucose but also IRI had decreased during the passage of the plasma through the dialyzer. In HD patients with diabetes, the glucose content of the hemodialysis solution plays an important role in preventing acute hypoglycemia and hyperglycemia on HD days.