Osman YOKUŞ, Murat ALBAYRAK, Alaattin YILDIZ

Kronik böbrek yetmezliğinde oral kalsitriol tedavisinin insülin direnci üzerine etkisi

Çalışmamızda daha önce D vitamini tedavisi görmemiş üremik prediyaliz ve hemodiyaliz hastalarında, bir aylık D vitamini tedavisinin periferik insülin direnci üzerine olan etkisi değerlendirildi. Bu çalışmada prediyaliz dönemdeki beş üremik hasta ile hemodiyalize girmekte olan 15 hasta olmak üzere toplam 20 hasta incelendi. Hastalardan çalışma öncesi kanda bazal serum kalsiyum, fosfor, glukoz, parathormon, insülin, C-peptid, kalsitonin bakılıp oral glukoz tolerans testi (OGTT) uygulandı ve glukoz, insülin, C-peptid değerlerine test esnasında bakıldı. Dört haftalık D vitamini tedavisi sonrası testler tekrarlandı. Endojen insülin hassasiyeti göstergesi olan glukoz/insülin oranı D vitamini tedavisi sonrası tedavi öncesine göre prediyaliz hastalarında anlamlı olarak artarken, hemodiyaliz hastalarında anlamlı artış saptanmadı. İnsülin direncinin bir göstergesi olan HOMA testinde (insülin direnç testi), prediyaliz grubunda D vitamini sonrasında anlamlı azalma saptandı (p=0.043). Hemodiyaliz grubunda ise D vitamini tedavisi sonrasında HOMA değerlerinde azalma saptanmasına karşın istatistiksel anlamlılığa ulaşmadı (p=0.23). HOMA, 30. dakika glukoz düzeyi ve AUC glukoz parametreleri hem D vitamini tedavisi öncesi hem de tedavi sonrası hemodiyaliz hastalarında prediyaliz hastalarından anlamlı olarak düşük bulunmuştur. Çalışmamızda D vitamini tedavisi ile her iki grupta endojen insülin hassasiyetinin arttığı gözlenmiştir. Bu bulgu prediyaliz grubunda daha belirgin olarak saptanmıştır. Bu sonucun muhtemelen hemodiyalizin karbonhidrat metabolizması üzerindeki iyileştirici etkisinin, D vitamininin etkisini maskelemesi ile ilgili olabileceği düşünülmüştür. Çalışmamızda üremide gözlenen insülin direnci üzerine hem hemodiyalizin, hem de D vitamini tedavisinin olumlu etkileri mevcuttur. Hemodiyalizin tek başına D vitamini tedavisinden daha etkili olduğu sonucuna varılmıştır.

The affect of oral calcıtrıol treatment on insulın resıstance in chronıc renal faılure

We investigated the affect of monthly vitamin D treatment on insulin resistance in vitamin D therapy naive uremic patients undergoing hemodialysis or not. We included 20 chronic renal disease patients in the study (15 out of 20 were undergoing hemodialysis, 5 were not). Serum calcium, phosphor, glucose, parathormone, insuline, C-peptide, calcitonin were checked and oral glucose tolerance test was performed before and after the monthly vitamin D treatment. After vitamin D therapy, there were an increasing in Glucose/ insuline level in patients not undergoing hemodialysis, in contrast no differences in patients with hemodialysis. HOMA score was also decreased according to the vitamin D therapy in patients not undergoing hemodialysis (p=0.043). The decline in HOMA score in patients with hemodialysis did not reach to statistically significancy (p=0.23).HOMA score, glucose level at 30th minutes and AUC glucose parameters were lower in patients with hemodialysis than not undergoing hemodialysis in both pre- and after treatment intervals. Endogenous insulin sensitivity increased in both groups pf patients after vitamin D treatment even the declining was more prominent in patients not undergoing hemodialysis. The affect of vitamin D therapy was probable masked by the positive influence of hemodialysis on carbohydrates methabolism. Our results showed that both vitamin D therapy and hemodialysis have positive affects on insuline resistance. However, this positive influence was greater via vitamin D therapy than hemodialysis.

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