Abstract
Although the carbohydrate intolerance in renal failure is well documented, its pathogenesis remains unsettled. The present studies were undertaken to elucidate the mechanism of abnormal carboh ydrate intolerance in canal failure, and to evaluate the efficacy of long-term intermittent dialysis. Materials and methods The blood glucose, plasma insulin and plasma growth hormone responses to the intravenous injection of 0.5 g/kg body weight glucose were studied in 55 sujects, divided into 3 groups: 25 patients with azotemia (20 of them were treated with dialysis), 3 normal subjects and 27 patients with slight to moderate impairment of renal function. Results 1) In 14 of 16 azotemic non-dialyzed patients with creatinine clearance under 20ml/min, an abnormal responses to intravenous glucose administration were found (glucose decay constant K<1.5). 2) Abnormal K-values in azotemic subjects progressively improved month by month and almost completely normalized at the end of about 6 months of regular dialysis (peritoneal dialy sis and hemodialysis), twice a week. 3) Plasma growth hormone resposes after intravenous glucose administration were correlated with renal function, and highly azotemic subjects especially, showed a paradoxical rise in 60 to 90 min, after intravenous glucose administration . Cases with improvement of carbohydrate intolerance due to long-term dialysis revealed more abnormal plasma growth hormone responses to glucose administratio n than those with incomplete improvement after short-term dialysis. Conclusions 1) Abnormal carbohydrate intolerance was found in azotemic patients, and its degree was correlated with that of impairment of renal function. 2) The carbohydrate intolernce in azotemic stage was improved in respons to long -term dialysis, no to short-term dialysis. 3) There were no correlations between the factors influencing the glucose intolerance and those influencing the growth hormone responses . The former is thought to be dialyzable, the latter, in contrast, is non-dialyzable.
