Nutritional analysis and comparison of serum insulin concentrations pre- and post-hemodialysis in a diabetic end stage renal disease population

Abstract

Diabetics comprise a growing percentage of the population with end stage renal disease commencing dialysis therapy. The purpose of this study was to determine the nutritional status and serum insulin concentrations pre- and posthemodialysis of this population. Sixty-seven adults who received daily insulin injections and attended hemodialysis therapy thrice weekly completed the study. The subjects used high efficiency, high flux and conventional dialyzers. The serum insulin concentrations were determined in duplicate, using a solid phase 1251 radioimmunoassay procedure. Upon comparison, using a Student's paired t test, the total sample's mean post-hemodialysis serum insulin concentration was significantly lower than the mean pre-hemodialysis serum insulin concentration (p < 0.05). The subject's nutritional intake histories were recorded for typical dialysis and non dialysis days. The records were analyzed, using the Nutritionist IV Dietary Analysis Computer Program, version 3.5. Age and sex appropriate Recommended Dietary Allowances were used for each subject and the goals were set at 67% of the RDAs. The goals for energy and protein intake were calculated for each subject, based on estimated dry vveight. The energy intake goal was 35 kcal/kg/day and the protein intake goal was 1.5 gm/kg/day. There were no significant differences between the mean nutrients intakes on the two typical days. The mean intakes of six nutrients were below the goals on one or both days. For dialysis and non-dialysis days, the mean energy intakes were 60.67 ± 23.57 (21.23 kcal/kg) and 62.94 ± 25.67 (22.03 kcal/kg) and the mean protein intakes were 72.07 ± 31.49 (1.08 gm/kg) and 71.93 ± 31.49 (1.079 gm/kg}, respectively. Both energy and protein intakes were signficantly less that the goal of 100% (p < 0.0001 ). Vitamin D, calcium and magnesium vvere significantly less than the goal of 67% of the RDAs on one or both days (p <0.02). Zinc intake was deficient on one day, but not statistically significant. Many nutrients had mean intakes of 0%.