Anti-inflammatory effect of an insulin infusion in patients on maintenance haemodialysis: A randomized controlled pilot study
Article first published online: 23 MAR 2010
© 2011 The Authors. Nephrology © 2011 Asian Pacific Society of Nephrology
Volume 16, Issue 1, pages 68–75, January 2011
How to Cite
VOS, F. E., MANNING, P. J., SUTHERLAND, W. H., SCHOLLUM, J. B. and WALKER, R. J. (2011), Anti-inflammatory effect of an insulin infusion in patients on maintenance haemodialysis: A randomized controlled pilot study. Nephrology, 16: 68–75. doi: 10.1111/j.1440-1797.2010.01329.x
- Issue published online: 23 MAR 2010
- Article first published online: 23 MAR 2010
- Accepted manuscript online: 28 JUN 2010 07:07AM EST
- Accepted for publication 17 March 2010.Accepted manuscript online 23 March 2010.
- C-reactive protein;
- oxidative stress
Aim: A pilot study to investigate the anti-inflammatory effect of insulin in patients on maintenance haemodialysis.
Background: Elevated concentrations of pro-inflammatory and oxidative mediators are thought to contribute to the increased cardiovascular risk in haemodialysis. Insulin has been demonstrated to have anti-inflammatory properties and a continuous low-dose insulin infusion in critically ill patients is associated with improved outcomes. The anti-inflammatory effects of insulin in haemodialysis have not been investigated.
Methods: In a single-blind cross-over study, 11 stable, non-diabetic, haemodialysis patients received a continuous insulin infusion (Actrapid 2 IU/h) during a dialysis of 4 h or a conventional dialysis in random order. Normoglycaemia was maintained by a modified glucose dialysate and glucose infusion. Blood samples were collected at baseline, 1, 4, 6 and 24 h. C-reactive protein (CRP), tumour necrosis factor-α, interleukin-6, neopterin, vascular cell adhesion molecule 1, protein thiols, dityrosine and peroxides were measured.
Results: Insulin produced a significant reduction in median CRP over the immediate dialysis phase (confidence interval) by 6% (2–9% (95% CI), P = 0.006) and an even greater decline at 24 h (19% (8–28%, 95% CI), P = 0.001) compared with values of the conventional dialysis. No significant changes were observed in the other markers. Median glucose levels were comparable during both dialysis sessions.
Conclusions: During haemodialysis, insulin may have a modest anti-inflammatory effect as evident by a reduction in CRP that appears to have a persistent effect over the next 24 h post dialysis. More studies are required to examine longer-term benefits as well as the potential role in more high-risk individuals.