Effect of chronic renal failure and hemodialysis on carbohydrate metabolism.

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Abstract
Five patients with abnormal glucose tolerance and chronic renal failure severe enough to require hemodialysis were studied. Assured that calorie intake was adequate, the patients were studied with tests of carbohydrate tolerance. In addition, serum immunoreactlve insulin (IRI) and free fatty acids [FFA] were determined in response to intravenous glucose (ivGTT). There is a defect in carbohydrate metabolism present in uremia that is not related to secondary factors, such as starvation or latent diabetes mellitus. This abnormality does not appear to be related to urea per se. The glucose Intolerance can be corrected with freqeunt hemodialysis, but a minimal recovery period (approximately 2 weeks) is necessary. The insulin insensittvlty and abnormal response to intravenous tolbuta-mide are also corrected with dialysis. The carbohydrate abnormality will reappear within 7 days if dialysis is withheld. There is a decreased serum IRI response to IvGTT noted primarily within the first 10 minutes of testing. Circulating FFA levels were not significantly different during periods of normal and abnormal glucose tolerance.