Düzenli hemodiyaliz tedavisi uygulanan hastalarda L-karnitin tedavisinin insülin direnci ve lipit profili üzerine etkileri

Abstract

Findings: We established insulin resistance (H0MA-IR>1,93) in %24 of patients. A significant relation was'nt determined between HOMA-IR and PTH levels, hematocrit value and rHuEpo treatment (p>0,05). Significant change was'nt determined im HOMA-IR, insulin, glucose, total cholesterol, triglyceride, HDL-C, LDL-C levels after treatment in L-carnitine group (p>0,05). Also there was'nt a significant change in HOMA-IR, glucose, total cholesterol, triglyceride, HDL-C, LDL-C levels in placebo conrol group (p>0,05). Significant increase was determined in insulin levels (p<0,05). Result: We established that IR, has a predictor role on cardiovasculer mortality in ESRD, is a reversible risk factor by adequate hemodialysis therapy. L-carnitine did'nt made evident effect on IR and lipid levels. 65ilişki saptanmadı (p>0,05). L karnitin grubunda tedavi sonrası HOMA-IR, insülin, glukoz, total kolesterol, trigliserid, HDL-K, LDL-K değerlerinde anlamlı değişiklik görülmedi (P>0,05). Plasebo kontrol grubunda da tedavi sonrası HOMA-IR, glukoz, total kolesterol, trigliserid, LDL-K, HDL-K' de anlamlı değişiklik görülmedi (P>0,05). însülin düzeylerinde ise anlamlı artış saptandı (p<0,05). Sonuç: Yeterli HD tedavisiyle SDBH'da kardiyovasküler mortalite üzerinde belirleyici bir rolü olan IR'nın değiştirilebilir bir risk faktörü olduğunu tespit ettik. L karnitin tedavisi ise İR ve lipid profiline belirgin bir etki yapmamıştır. SUMMARY Aim: Cardiovasculer diseases are major mortality causes in patients that underwent to hemodialysis and periton dialysis as it is in normal population. însülin resistance is associated with cardiovasculer diseases that develops on the basis of atherogenesis. The relation between uremia and insulin resistance are known for many years. Uremia also causes lipid metabolism disorders. We studied prevelance of HOMA-IR, relation of HOMA-IR and other parameters, and effect of L-carnitine teratment on IR and lipid levels in hemodialysis patients. Materials and Method: 58 patients (23 men, 35 women) mat were underwent to hemodialysis three times in a week for at least six months were included. Patients that were diabetic, has a family history of diabetes, obese, unstabil and suffered from active infection were excluded. Patients were divided in two groups as L- carnitine therapy group (n:29) and placebo control group (n:29). There was not a difference between grups according to average age, duration of hemodialysis, BMI and dialysis adequacy (Kt/V). Mean age was 39±13,6 in L-carnitine grup and 39±12,8 in placebo group. L-carnitine was given 1 g IV after each dialysis for one months. 5 cc serum physiologic was given after each dialysis in placebo control group. H0MA-IR>1,93 accepted as insulin resistance. Patients were classified according to PTH levels, hematocrit values and rHuEpo treatment. HOMA-IR values were compared. Blood samples were collected at 8:30 am after 12 hours hunger. It was measured in Central Laboratory of Dicle University Medical Faculty. 64

ilişki saptanmadı (p>0,05). L karnitin grubunda tedavi sonrası HOMA-IR, insülin, glukoz, total kolesterol, trigliserid, HDL-K, LDL-K değerlerinde anlamlı değişiklik görülmedi (P>0,05). Plasebo kontrol grubunda da tedavi sonrası HOMA-IR, glukoz, total kolesterol, trigliserid, LDL-K, HDL-K' de anlamlı değişiklik görülmedi (P>0,05). însülin düzeylerinde ise anlamlı artış saptandı (p<0,05). Sonuç: Yeterli HD tedavisiyle SDBH'da kardiyovasküler mortalite üzerinde belirleyici bir rolü olan IR'nın değiştirilebilir bir risk faktörü olduğunu tespit ettik. L karnitin tedavisi ise İR ve lipid profiline belirgin bir etki yapmamıştır. SUMMARY Aim: Cardiovasculer diseases are major mortality causes in patients that underwent to hemodialysis and periton dialysis as it is in normal population. însülin resistance is associated with cardiovasculer diseases that develops on the basis of atherogenesis. The relation between uremia and insulin resistance are known for many years. Uremia also causes lipid metabolism disorders. We studied prevelance of HOMA-IR, relation of HOMA-IR and other parameters, and effect of L-carnitine teratment on IR and lipid levels in hemodialysis patients. Materials and Method: 58 patients (23 men, 35 women) mat were underwent to hemodialysis three times in a week for at least six months were included. Patients that were diabetic, has a family history of diabetes, obese, unstabil and suffered from active infection were excluded. Patients were divided in two groups as L- carnitine therapy group (n:29) and placebo control group (n:29). There was not a difference between grups according to average age, duration of hemodialysis, BMI and dialysis adequacy (Kt/V). Mean age was 39±13,6 in L-carnitine grup and 39±12,8 in placebo group. L-carnitine was given 1 g IV after each dialysis for one months. 5 cc serum physiologic was given after each dialysis in placebo control group. H0MA-IR>1,93 accepted as insulin resistance. Patients were classified according to PTH levels, hematocrit values and rHuEpo treatment. HOMA-IR values were compared. Blood samples were collected at 8:30 am after 12 hours hunger. It was measured in Central Laboratory of Dicle University Medical Faculty. 64Findings: We established insulin resistance (H0MA-IR>1,93) in %24 of patients. A significant relation was'nt determined between HOMA-IR and PTH levels, hematocrit value and rHuEpo treatment (p>0,05). Significant change was'nt determined im HOMA-IR, insulin, glucose, total cholesterol, triglyceride, HDL-C, LDL-C levels after treatment in L-carnitine group (p>0,05). Also there was'nt a significant change in HOMA-IR, glucose, total cholesterol, triglyceride, HDL-C, LDL-C levels in placebo conrol group (p>0,05). Significant increase was determined in insulin levels (p<0,05). Result: We established that IR, has a predictor role on cardiovasculer mortality in ESRD, is a reversible risk factor by adequate hemodialysis therapy. L-carnitine did'nt made evident effect on IR and lipid levels. 65