الفهرس 
Anemia in ESRDOnly 14 pages are availabe for public view
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Abstract
IR is a characteristic feature of uremia. As long as hyperinsulinemia is adequate to overcome IR, glucose tolerance remains normal. IR and the metabolic syndrome are common in patients with CKD and they predict subsequent cardiovascular events and mortality.
IR results from a combination of genetic and environmental factors, few studies have shown a favorable effect of erythropoietin in decreasing IR. IR, as a potentially modifiable cardiovascular risk factor is currently considered as a therapeutic target in CKD patients.
The present study was conducted to assess the possible effects of short term treatment with EPO on the degree of IR (IR) in 20 hemodialysis patients not receiving erythropoietin (control) compared to other 40 (HDP) divided into 2 groups 20 diabetics and 20 non-diabetic both receiving erythropoietin (Intervention group).
All patients gave written consent and were thoroughly examined in detail and all basic laboratory investigations were done including serum fasting insulin levels, HbA1C, fasting blood glucose. Patients were evaluated every month for adherence to treatment, adverse effects and outcome.
In this study, IR was calculated by HOMA-IR (Homeostasis model assessment), a computer generated model, because of its simplicity and it requires only measurement of the fasting plasma insulin and plasma glucose.
The results of present work showed a significant decrease (p-value < 0.05) in the mean values of fasting insulin as well as IR calculated by HOMA-IR in the intervention group at six months as compared to the base line. On the other hand the control group showed insignificant changes.
The results of present work showed a significant decrease (p-value < 0.05) in the mean values of HbA1C in the intervention group after six months as compared to base line on the other hand the control group showed insignificant changes.
In conclusion EPO treatment in hemodialysis patients is followed by improvement in IR in the intervention group as evidenced by a significant decline of HOMA-IR, HbA1C and fasting blood glucose. This improvement of IR is independent of anemia correction and it is linked mostly to duration of HD. On the other hand the control group showed insignificant changes.