Effect of Hematodialysis Combined with Hemoperfusion on Insulin Resistance and Nutritional Status of Patients with End-Stage Diabetic Nephropathy

Objective: To explore the effect of hematodialysis (HD) combined with hemoperfusion (HP) on the insulin resistance (IR) and nutritional status of patients with end-stage diabetic nephropathy (ESDN). Methods: Eighty-six patients with ESDN were randomly divided into group A (n=28), group B (n=30) and group C (n=28), and another 24 healthy volunteers were selected as control group. Groups A, B and C were respectively treated with routine HD, HD combined with hemodiafiltration (HDF) as well as HD combined with HP. The levels of C-reactive protein (CRP), tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) as well as the changes ofurea nitrogen(Scr), fasting blood glucose (FBG), fasting insulin (FINS), homeostasis model assessment of insulin resistance (Homa-IR), hemoglobin (Hb), albumin (Alb) and body mass index (BMI) were compared among groups before and 12 weeks after treatment. (BUN), creatinine Results: 12 weeks after treatment, the levels of CRP, TNF-α and IL-6 in group A did not change obviously, whereas those in groups B and C decreased dramatically when compared with treatment before (P<0.05 or P<0.01), in which the decreased range in group C was the most significant, but it was still higher than in control group (P<0.01). There was no statistical significance among three groups with regard to the levels of BUN and Scr before and 12 weeks after treatment (P>0.05). Compared with treatment before, FBG and FINS levels as well as Homa-IR reduced (P<0.05 or P<0.01), Hb, Alb and BMI elevated markedly in group C 12 weeks after treatment (P<0.01), while those in groups A and B did not change conspicuously (P>0.05). FBG, FINS and Homa-IR were all lower, but Hb, Alb and BMI were markedly higher in group C than in groups A and B 12 weeks after treatment, and significant differences were shown (P<0.05 or P<0.01).Conclusion: HD combined with HP can effectively remove the mid- and macro-molecular inflammatory mediators in the patients with ESDN, alleviate IR and ameliorate the nutritional status to reduce the incidence of malnutrition