Insulin Is Protein-Anabolic in Chronic Renal Failure Patients

ABSTRACT. To examine the protein anabolic actions of insulin in chronic renal failure, the authors measured four sets of whole body leucine fluxes during insulin alone and insulin with amino acid infusion in nine uremic patients before hemodialysis (B-HD). Seven were restudied 8 wk after initiation of maintenance hemodialysis (HD). Six normal subjects served as control (N). All values (μmol/kg/h, mean ± SEM) are presented in the sequence of B-HD, HD, and N, and only P P = 0.02); S were 77 ± 4, 87 ± 5, and 76 ± 5, respectively, and balances were −12 ± 1, −11 ± 2, and −18 ± 1, respectively ( P = 0.02). During Flux 3 (high-dose insulin infusion): D were 77 ± 3, 82 ± 7, and 84 ± 5, respectively; C were 9 ± 1, 8 ± 1, and 14 ± 1, respectively ( P = 0.005); S were 68 ± 4, 74 ± 6, and 70 ± 5, respectively, and balances were −9 ± 1, −8 ± 1, and −14 ± 1, respectively ( P = 0.005). In Flux 4 (insulin infused with amino acids): D were 73 ± 3, 107 ± 18, and 85 ± 7, respectively; C were 35 ± 4, 29 ± 5, and 39 ± 3, respectively; S were 105 ± 5, 145 ± 15, and 113 ± 6, respectively ( P = 0.02), and balances were 32 ± 4, 38 ± 5, and 27 ± 3, respectively. These data show that B-HD and HD patients were as sensitive as normal subjects to the protein anabolic actions of insulin. Insulin alone reduced proteolysis and leucine oxidation, and insulin given with amino acids increased net protein synthesis. E-mail: victoria-lim@uiow.edu