Hormonal and metabolic responses to intravenous glucose in children on regular hemodialysis.

Blood glucose, plasma nonesterified fatty acids, amino acids, immunoreactive insulin, growth hormone, and immunoreactive glucagon responses to intravenous glucose were determined in 16 children on regular hemodialysis for chronic renal failure and nine healthy children. In the patients the fractional disappearance rate of glucose was significantly reduced, basal immunoreactive insulin was significantly raised, and while the early immunoreactive insulin response to glucose was similar in patients and controls, the late response was increased. Basal growth hormone was elevated in the patients and rose paradoxically following glucose. Fasting immunoreactive glucagon was significantly higher in the patients and was not suppressed by glucose. Plasma nonesterified fatty acid levels were lower in the patients and fell more markedly after glucose. Alanine levels, which were significantly raised in those with poor glucose tolerance, fell to normal after glucose and did not vary in those with more normal glucose tolerance. It is speculated that the metabolic and hormonal alterations may be interrelated and result from failure of normal glucose utilization.