The incidence and prevalence of treated end-stage renal disease (ESRD) have been steadily increased over the past decades across countries. In 2014, Taiwan has reported the highest number of treated ESRD with 455 new cases and the prevalence of 3219 patients per million general population (PMP). Taiwan has also experienced the highest number of maintenance hemodialysis in the world with 3093 patients PMP, 90% of them receiving in-center hemodialysis [
Cardiovascular disease (CVD) has been reported as the leading cause of death and disability all over the world. In 2013, CVD accounted for about 17 million deaths and 329 million disability adjusted life-years lost [
Insulin resistance (IR) is with high prevalence in the ESRD patients [
The ESRD has created a heavy burden for the healthcare system all around the world over the past decade [
A clinical cross-sectional study was conducted between September 2013 and April 2017 in seven dialysis centers in Taiwan. A total of 384 hemodialysis patients were recruited from Taipei Medical University Hospital (55 patients collected from September to December 2013; 42 patients collected from November 2016 to January 2017); Taipei Medical University, Wan Fang Hospital (51 patients collected from April to May 2014); Taipei Medical University, Shuang Ho Hospital (39 patients collected in December 2014); Cathay General Hospital (41 patients collected in March 2016); Taipei Tzu-Chi Hospital (57 patients collected in November 2016); Wei-Gong Memorial Hospital (59 patients collected from February to March 2017); and Lotung Poh-Ai Hospital (50 patients collected in April 2017).
We included patients aged above 20 years, receiving thrice-weekly hemodialysis treatment for at least 3 months and adequate dialysis quality (equilibrated Kt/V ≥ 1.2 g/kg/day). The exclusion criteria were patients who were diagnosed with pregnancy, amputation, hyperthyroidism, hypothyroidism, and malignancy, received tube feeding, exhibited hepatic failure or cancer, were hospitalized within one month prior to the recruitment, or were scheduled for surgery. Volume overload or edema closely linked with other clinical instability [
The eligible patients in selected hospitals signed the informed consents before conducting chart reviews and laboratory evaluations. The patients’ medical records were reviewed. The blood samples were collected by licensed nurses, at the start of the first dialysis session of the week, and then analyzed in the hospital laboratory by using commercially available test kits, which was described carefully in previous studies [
The blood samples collected by the registered nurse were centrifuged in each hospital laboratory. The serum was separated and kept in the ice-pack, then sent to the laboratory in Taipei Medical University Hospital for serum insulin analysis. Therefore, all samples were analyzed with the same commercial kit. The homeostatic model assessment of insulin resistance index (HOMA-IR) is used to assess IR. The index is calculated using the formula developed by Matthews et al. [
The traditional and nontraditional CVD risks were described in the previous study [
The traditional risks of cardiovascular diseases include factors which were mentioned in previous studies [
Anemia: the targeted hemoglobin (Hb) level should be 11g/dL or greater, as moderately strong recommended by The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) Work Group [
The descriptive analyses describe the patients’ characteristics, insulin resistance (IR), cardiovascular disease risk factors via the mean, standard deviation, or median, interquartile range, frequency, and percentage. The independent-samples t-test, Chi-square test, and Mann-Whitney
The study is approved by the Joint Institutional Review Board of Taipei Medical University (TMU-JIRB No. 201302024), which was for conducting the study in three hospitals of Taipei Medical University (Taipei Medical University Hospital, Wan-Fang Hospital, Shuang Ho Hospital), Wei-Gong Memorial Hospital, and Lotung Poh-Ai Hospital; the ethical committee of Cathay General Hospital (CGH-OP104001); and Taipei Tzu-Chi Hospital (04-M11-090). All patients involved in the study have signed the informed consent statement.
Of the total sample, the average age of patients was 60.9 ± 11.8, 58.1% men, and 40.3% overweight or obese. The traditional CVD risk factors included high SBP (82.8%), high DBP (25.5%), high TC (16.7%), high LDL-C (48.4%), low HDL-C (65.9%), high TG (40.6%), and impaired fasting glucose (69.5%). The nontraditional CVD risks included anemia (58.3%), low calcium (8.3%), high calcium (35.2%), low phosphate (7.0%), high phosphate (35.4%), high calcium-phosphate product (25.5%), high intact parathyroid hormone (42.7%), hyperhomocysteinemia (85.7%), elevated hs-CRP (45.6%), and low serum albumin (12.0%; Table
Characteristics of hemodialysis patients.
Total sample | BMI < 24.0 | BMI ≥ 24.0 | p value | Non-DM | DM | p value | |
| |||||||
Characteristics | |||||||
Age, years | 60.9 ± 11.8 | 61.0 ± 12.0 | 60.7 ± 11.5 | 0.809 | 59.4 ± 11.9 | 63.0 ± 11.2 | 0.003 |
Gender | 223 (58.1%) | 127 (55.5%) | 96 (61.9%) | 0.207 | 129 (56.1%) | 94 (61.0%) | 0.335 |
Dialysis vintage, years | 5.5 ± 4.9 | 6.1 ± 5.4 | 4.7 ± 4.0 | 0.007 | 6.8 ± 5.6 | 3.7 ± 2.8 | <0.001 |
CCI score | 4.7 ± 1.6 | 4.6 ± 1.6 | 4.8 ± 1.5 | 0.295 | 4.1 ± 1.4 | 5.5 ± 1.3 | <0.001 |
PA, MET-min/wk | 4911.6 ± 1871.8 | 4874.5 ± 1900.3 | 4966.5 ± 1833.7 | 0.637 | 4964.7 ± 1929.0 | 4832.4 ± 1786.3 | 0.498 |
BMI, kg/m2 | 23.5 ± 3.9 | 21.0 ± 1.9 | 27.2 ± 3.0 | <0.001 | 22.6 ± 3.4 | 24.9 ± 4.1 | <0.001 |
DM | 154 (40.1%) | 66 (28.8%) | 88 (56.8%) | <0.001 | - | - | - |
HTN | 191 (49.7%) | 107 (46.7%) | 84 (54.2%) | 0.151 | 108 (47.0%) | 83 (53.9%) | 0.183 |
CVD | 115 (29.9%) | 63 (27.5%) | 52 (33.5%) | 0.205 | 55 (23.9%) | 60 (39.0%) | 0.002 |
Traditional CVD risks | |||||||
SBP ≥ 130 mmHg | 318 (82.8%) | 189 (82.5%) | 129 (83.2%) | 0.860 | 181 (78.7%) | 137 (89.0%) | 0.009 |
DBP ≥ 85 mmHg | 98 (25.5%) | 60 (26.2%) | 38 (24.5%) | 0.710 | 59 (25.7%) | 39 (25.3%) | 0.942 |
TC ≥ 200 mg/dL | 64 (16.7%) | 33 (14.4%) | 31 (20.0%) | 0.149 | 38 (16.5%) | 26 (16.9%) | 0.926 |
LDL-C ≥ 100 mg/dL | 186 (48.4%) | 39 (17.0%) | 32 (20.6%) | 0.371 | 45 (19.6%) | 26 (16.9%) | 0.507 |
HDL-C < 40 mg/dL for men, < 50 mg/dL for women | 253 (65.9%) | 133 (58.1%) | 120 (77.4%) | <0.001 | 132 (57.4%) | 121 (78.6%) | <0.001 |
TG ≥ 150 mg/dL | 156 (40.6%) | 68 (29.7%) | 88 (56.8%) | <0.001 | 68 (29.6%) | 88 (57.1%) | <0.001 |
IFG (FPG ≥ 100 mg/dL, or DM) | 267 (69.5%) | 145 (63.3%) | 122 (78.7%) | 0.001 | 113 (49.1%) | 154 (100.0%) | <0.001 |
Non-traditional CVD risks | |||||||
Hemoglobin < 11 g/dL | 224 (58.3%) | 137 (59.8%) | 87 (56.1%) | 0.471 | 131 (57.0%) | 93 (60.4%) | 0.504 |
Calcium < 8.4 mg/dL | 32 (8.3%) | 17 (7.4%) | 15 (9.7%) | 0.017 | 18 (7.8%) | 14 (9.1%) | 0.906 |
Calcium > 9.5 mg/dL | 135 (35.2%) | 69 (30.1%) | 66 (42.6%) | 81 (35.2%) | 54 (35.1%) | ||
Phosphate < 3.5 mg/dL | 27 (7.0%) | 16 (7.0%) | 11 (7.1%) | 0.079 | 16 (7.0%) | 11 (7.1%) | 0.992 |
Phosphate > 5.5 mg/dL | 136 (35.4%) | 71 (31.0%) | 65 (41.9%) | 82 (35.7%) | 54 (35.1%) | ||
Ca x PO4 ≥ 55 mg2/dL2 | 98 (25.5%) | 45 (19.7%) | 53 (34.2%) | 0.001 | 58 (25.2%) | 40 (26.0%) | 0.868 |
i-PTH ≥ 300 pg/mL | 164 (42.7%) | 99 (43.2%) | 65 (41.9%) | 0.801 | 111 (48.3%) | 53 (34.4%) | 0.007 |
Hcy > 14 | 329 (85.7%) | 196 (59.6%) | 133 (40.4%) | 0.953 | 195 (59.3%) | 134 (40.7%) | 0.541 |
hs-CRP > 0.3 mg/L | 175 (45.6%) | 59 (25.8%) | 55 (35.5%) | 0.041 | 60 (26.1%) | 54 (35.1%) | 0.059 |
Albumin ≤ 3.5 g/dL | 46 (12.0%) | 26 (11.4%) | 20 (12.9%) | 0.646 | 19 (8.3%) | 27 (17.5%) | 0.006 |
Serum K ≥ 5.0 mEq/L | 135 (35.2%) | 82 (35.8%) | 53 (34.2%) | 0.745 | 88 (38.3%) | 47 (30.5%) | 0.119 |
HOMA-IR | 5.4 (2.2, 11.0) | 3.9 (1.7, 9.8) | 6.9 (3.8, 14.3) | <0.001 | 4.1 (1.8, 9.9) | 6.4 (3.3, 12.5) | <0.001 |
Others | |||||||
Pre-BUN, mg/dL | 72.5 ± 19.9 | 72.6 ± 19.6 | 72.3 ± 20.5 | 0.870 | 73.9 ± 20.7 | 70.4 ± 18.6 | 0.090 |
Post-BUN, mg/dL | 20.0 ± 10.4 | 19.2 ± 12.0 | 21.2 ± 7.2 | 0.066 | 19.6 ± 7.6 | 20.6 ± 13.5 | 0.362 |
Uric acid, mg/dL | 7.3 ± 1.3 | 7.1 ± 1.2 | 7.5 ± 1.4 | 0.002 | 7.4 ± 1.2 | 7.0 ± 1.3 | 0.003 |
Creatinine, mg/dL | 11.1 ± 2.2 | 10.7 ± 1.8 | 11.7 ± 2.4 | <0.001 | 11.4 ± 2.0 | 10.6 ± 2.2 | 0.001 |
FPG, mg/dL | 132.4 ± 58.1 | 127.2 ± 59.8 | 139.9 ± 54.9 | .036 | 113.0 ± 41.7 | 161.3 ± 66.7 | <0.001 |
FPI, | 17.2 (8.8, 32.0) | 14.1 (6.8, 27.0) | 23.0 (12.7, 36.8) | <0.001 | 15.5 (7.6, 32.4) | 19.2 (9.7, 31.6) | 0.283 |
Categorical data is shown as n (%). Continuous data is presented as mean ± SD or median (interquartile range). P values calculated using Chi-square test, independent-samples T test, or Mann-Whitney
BMI, body mass index; DM, diabetes mellitus; HTN, hypertension; CVD, cardiovascular diseases; CCI, Charlson comorbidity index; PA, physical activity; MET, metabolic equivalent minute/ week; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglyceride; IFG, impaired fasting glucose; CaxPO4, calcium phosphate product; iPTH, intact parathyroid hormone; Hcy, homocysteine; hs-CRP, high sensitive C-reactive protein; K, serum potassium; HOMA-IR, homeostatic model assessment of insulin resistance; BUN, blood urea nitrogen; FPG, fasting plasma glucose; FPI: fasting plasma insulin.
In comparison with normal weight patients, those with overweight/obese had a higher prevalence of low HDL-C, high TG, IFG, low serum Ca, elevated CaxPO4, elevated hs-CRP, and elevated HOMA-IR (p < .05). On the other hand, patients with DM had a higher proportion of high SBP, low HDL-C, high TG, IFG, elevated iPTH, low serum albumin, and elevated HOMA-IR, as compared with non-DM patients (p < .05; Table
The results of multivariate regression analyses are shown in Tables
Odd ratios of having traditional cardiovascular risks among hemodialysis patients with insulin resistance.
High SBP | High DBP | High TC | High LDL-C | Low HDL-C | High TG | IFG | |
---|---|---|---|---|---|---|---|
OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | |
Normal weight | |||||||
Model 1 | 0.42 (0.20, 0.86) | 0.90 (0.50, 1.63) | 0.80 (0.38, 1.68) | 0.83 (0.49, 1.39) | 1.68 (0.99, 2.86) | 2.79 (1.54, 5.06) | 8.22 (4.35, 15.52) |
Model 2 | 0.36 (0.17, 0.76) | 1.13 (0.60, 2.12) | 0.81 (0.37, 1.75) | 0.78 (0.45, 1.36) | 1.75 (1.01, 3.06) | 3.41 (1.78, 6.53) | 8.15 (4.14, 16.02) |
Overweight/Obese | |||||||
Model 1 | 1.68 (0.71, 3.97) | 1.05 (0.51, 2.19) | 1.14 (0.52, 2.50) | 0.84 (0.45, 1.58) | 3.65 (1.58, 8.45) | 2.90 (1.50, 5.61) | 6.06 (2.33, 15.74) |
Model 2 | 1.69 (0.66, 4.29) | 0.75 (0.33, 1.68) | 0.99 (0.42, 2.33) | 0.80 (0.41, 1.55) | 4.15 (1.71, 10.06) | 3.06 (1.53, 6.13) | 10.76 (3.36, 34.5) |
Non-diabetes | |||||||
Model 1 | 0.69 (0.37, 1.31) | 1.15 (0.63, 2.07) | 0.78 (0.39, 1.56) | 0.90 (0.54, 1.51) | 2.38 (1.39, 4.07) | 3.40 (1.85, 6.25) | 10.64 (5.78, 19.58) |
Model 2 | 0.61 (0.31, 1.18) | 1.21 (0.64, 2.30) | 0.64 (0.31, 1.35) | 0.76 (0.44, 1.33) | 2.14 (1.23, 3.75) | 3.22 (1.69, 6.12) | 12.54 (6.39, 24.63) |
Diabetes | |||||||
Model 1 | 1.49 (0.54, 4.15) | 0.93 (0.45, 1.93) | 1.00 (0.43, 2.32) | 0.77 (0.41, 1.45) | 2.40 (1.07, 5.38) | 3.75 (1.91, 7.37) | |
Model 2 | 2.11 (0.70, 6.31) | 0.94 (0.43, 2.05) | 1.16 (0.44, 3.05) | 0.78 (0.40, 1.54) | 3.07 (1.28, 7.33) | 4.29 (2.05, 8.98) | |
Overall | |||||||
Model 1 | 0.80 (0.47, 1.37) | 1.00 (0.63, 1.58) | 0.80 (0.47, 1.37) | 0.72 (0.48, 1.07) | 2.65 (1.71, 4.11) | 3.67 (2.39, 5.66) | 8.14 (4.77, 13.89) |
Model 2 | 0.76 (0.43, 1.32) | 1.11 (0.68, 1.83) | 0.75 (0.42, 1.32) | 0.63 (0.41, 0.96) | 2.53 (1.59, 4.01) | 3.58 (2.25, 5.69) | 7.99 (4.50, 14.18) |
Significant level at
Model 1: elevated HOMA-IR and traditional CVD risk factors.
Model 2: adjusted for age, gender, hemodialysis vintage, Charlson comorbidity index, physical activity, and body mass index (for nondiabetes, diabetes, and overall sample).
SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglyceride; IFG, impaired fasting glucose.
Odd ratios of having nontraditional cardiovascular risks among hemodialysis patients with insulin resistance.
Anemia | Low Ca | High Ca | Low PO4 | High PO4 | High CaxPO4 | High iPTH | High Hcy | High CRP | Low Alb | Hyperkalemia | |
---|---|---|---|---|---|---|---|---|---|---|---|
OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | OR (95%CI) | |
Normal weight | |||||||||||
Model 1 | 1.17 (0.69, 1.99) | 0.99 (0.36, 2.72) | 0.68 (0.38, 1.21) | 1.86 (0.61, 5.62) | 0.52 (0.29, 0.93) | 0.47 (0.24, 0.93) | 0.77 (0.45, 1.30) | 1.08 (0.52, 2.27) | 2.19 (1.18, 4.03) | 9.25 (2.69, 31.79) | 0.39 (0.22, 0.68) |
Model 2 | 0.98 (0.55, 1.72) | 1.25 (0.42, 3.69) | 0.72 (0.39, 1.32) | 1.71 (0.54, 5.40) | 0.52 (0.28, 0.96) | 0.51 (0.25, 1.03) | 0.83 (0.48, 1.44) | 0.98 (0.45, 2.12) | 2.21 (1.16, 4.22) | 8.31 (2.35, 29.37) | 0.39 (0.22, 0.70) |
Overweight/Obese | |||||||||||
Model 1 | 0.84 (0.45, 1.59) | 4.27 (1.24, 14.69) | 1.86 (0.95, 3.65) | 3.72 (0.92, 15.08) | 1.63 (0.84, 3.15) | 1.26 (0.65, 2.45) | 1.39 (0.74, 2.65) | 0.96 (0.39, 2.36) | 0.80 (0.41, 1.55) | 0.83 (0.32, 2.13) | 0.71 (0.36, 1.38) |
Model 2 | 0.82 (0.41, 1.62) | 3.00 (0.80, 11.20) | 1.94 (0.96, 3.90) | 3.54 (0.84, 14.96) | 1.69 (0.82, 3.51) | 1.23 (0.60, 2.50) | 1.36 (0.68, 2.71) | 0.98 (0.38, 2.53) | 1.04 (0.51, 2.10) | 0.68 (0.25, 1.82) | 0.87 (0.42, 1.79) |
Non-diabetes | |||||||||||
Model 1 | 1.04 (0.62, 1.75) | 1.55 (0.57, 4.24) | 0.87 (0.50, 1.52) | 2.74 (0.84, 8.93) | 0.65 (0.37, 1.13) | 0.83 (0.46, 1.51) | 0.97 (0.58, 1.62) | 1.07 (0.52, 2.20) | 1.58 (0.87, 2.86) | 6.03 (1.71, 21.32) | 0.32 (0.18, 0.56) |
Model 2 | 1.04 (0.60, 1.82) | 1.44 (0.49, 4.20) | 0.75 (0.42, 1.36) | 2.62 (0.78, 8.85) | 0.51 (0.27, 0.95) | 0.62 (0.32, 1.22) | 0.86 (0.50, 1.48) | 1.01 (0.47, 2.16) | 1.58 (0.85, 2.95) | 6.59 (1.81, 23.95) | 0.31 (0.17, 0.57) |
Diabetes | |||||||||||
Model 1 | 1.18 (0.62, 2.25) | 2.38 (0.74, 7.71) | 1.79 (0.90, 3.55) | 2.24 (0.61, 8.22) | 1.73 (0.87, 3.42) | 1.00 (0.49, 2.06) | 1.50 (0.77, 2.93) | 0.63 (0.24, 1.64) | 1.26 (0.65, 2.44) | 2.31 (0.96, 5.52) | 1.06 (0.54, 2.11) |
Model 2 | 1.12 (0.56, 2.21) | 2.11 (0.55, 8.15) | 1.59 (0.77, 3.28) | 2.41 (0.62, 9.40) | 1.70 (0.82, 3.49) | 0.97 (0.45, 2.06) | 1.71 (0.82, 3.54) | 0.74 (0.27, 2.04) | 1.22 (0.60, 2.48) | 2.05 (0.80, 5.26) | 1.18 (0.57, 2.46) |
Overall | |||||||||||
Model 1 | 1.09 (0.73, 1.64) | 1.53 (0.72, 3.25) | 1.03 (0.67, 1.59) | 2.53 (1.06, 6.02) | 1.01 (0.66, 1.54) | 0.95 (0.60, 1.50) | 0.88 (0.59, 1.32) | 1.24 (0.70, 2.19) | 1.42 (0.91, 2.21) | 3.23 (1.62, 6.45) | 0.51 (0.33, 0.78) |
Model 2 | 1.06 (0.69, 1.63) | 1.38 (0.61, 3.15) | 0.95 (0.60, 1.49) | 2.35 (0.97, 5.71) | 0.99 (0.62, 1.57) | 0.89 (0.54, 1.46) | 0.93 (0.61, 1.43) | 1.27 (0.70, 2.30) | 1.30 (0.82, 2.06) | 3.07 (1.51, 6.23) | 0.56 (0.36, 0.88) |
Significant level at
Model 1: elevated HOMA-IR and traditional CVD risk factors.
Model 2: adjusted for age, gender, hemodialysis vintage, Charlson comorbidity index, physical activity, and body mass index (for nondiabetes, diabetes, and overall sample).
Ca, serum calcium; PO4, serum phosphorus; CaxPO4, calcium phosphorus product; iPTH, intact parathyroid hormone; hs-CRP, high sensitive C-reactive protein; Alb, serum albumin.
After being adjusted for age, gender, hemodialysis vintage, Charlson Comorbidity Index, and physical activity, and body mass index, in non-DM patients, IR was significantly linked with higher odds of low HDL-C (OR, 2.14, 95%CI, 1.23-3.75, p < .01), high TG (OR, 3.22, 95%CI, 1.69-6.12, p < .001), IFG (OR, 12.54, 95%CI, 6.39-24.63, p < .001), and hypoalbuminemia (OR, 6.59, 95%CI, 1.81-23.95, p <.01), but with lower odd of hyperkalemia (OR, 0.31, 95%CI, 0.17-0.57, p < .001). In DM patients, IR was significantly linked with higher odds of low HDL-C (OR, 3.07, 95%CI, 1.28-7.33, p < .05) and high TG (OR, 4.29, 95%CI, 2.05-8.98, p < .001). In overall sample, the elevated level of HOMA-IR was significantly associated with higher odds of low HDL-C (OR, 2.53, 95%CI, 1.59-4.01, p <.001), high TG (OR, 3.58, 95%CI, 2.25-5.69, p < .001), IFG (OR, 7.99, 95%CI, 4.50-14.18, p < .001), and hypoalbuminemia (OR, 3.07, 95%CI, 1.51-6.23, p <.01), but with lower odd of hyperkalemia (OR, 0.56, 95%CI, 0.36-0.88, p < .05; Tables
The level of IR is higher in overweight/obese and DM patients than in normal weight and non-DM patients in the current study. Obesity is also reported as the most common cause of IR previously [
In regard to traditional CVD risks, IR is significantly associated with a higher prevalence of dyslipidemia such as low HDL-C, high TG in the current study. The finding was also found in both the general population [
Regarding the nontraditional risks, the prevalence of elevated hs-CRP was higher in overweight/obese patients than those with normal weight. A previous study has also reported that patients with central obesity had higher hs-CRP level than those without [
In the current study, there is also no significant association between IR and hs-CRP in patients with DM or non-DM patients or overweight/obese, but it existed in normal weight patients. The association between IR and hs-CRP was found in the overall sample in Turkey [
There were some contradictory findings between the current study and the previous one. Firstly, the IR associated with a lower likelihood of having high SBP in the current study which was in contrast with the previous finding [
The study was of a cross-sectional nature; the causal relationship, therefore, cannot be generated. The interpretation of results should be cautious. The data related to supplement intake and medication was not explored. Therefore, the association between IR and some CVD risks was not well explained. Smoking is known as a major traditional cardiovascular risk factor. It is reported that 85.1% of patients were nonsmokers [
The insulin resistance (IR) and CVD risks were common in hemodialysis patients. IR was associated with a higher prevalence of dyslipidemia (low HDL-C, high TG), impaired fasting glucose, elevated hs-CRP, and hypoalbuminemia. Addressing the assessment and treatment of IR and CVD risks in clinical practice could help with improving the hemodialysis outcomes.
Since the dataset contains sensitive and identifying information, any modification or deidentification on the dataset is restricted. The authors confirm that the data is available upon request. Requests may be sent to the corresponding author, Shwu-Huey Yang (
The funder had no role in the decision to collect data, data analysis, or reporting of the results. The abstract was presented at the Annual Dialysis Conference 2018, Mar 3-6, 2018, Orlando, Florida.
The authors had no conflicts of interest relevant to this article to be disclosed.
Tuyen Van Duong consulted a statistician, analyzed and interpreted the data, and drafted the manuscript. Chun-Kuang Shih, Te-Chih Wong, Hsi-Hsien Chen, Tso-Hsiao Chen, Yung-Ho Hsu, Sheng-Jeng Peng, Ko-Lin Kuo, Hsiang-Chung Liu, and En-Tzu Lin contributed to conception and design, acquisition of data, and discussion. Chien-Tien Su and Shwu-Huey Yang contributed to the overall conception and design and critically reviewed the manuscript. All authors read and approved the final version of the manuscript.
The authors thank medical staff and patients from Taipei Medical University Hospital, Wan-Fang Hospital, Shuang Ho Hospital, Cathay General Hospital, and Taipei Tzu-Chi Hospital, Wei-Gong Memorial Hospital, and Lutong Poh-Ai Hospital. The authors also thank Chi-Sin Huang, I-Hsin Tseng, Yi-Wei Feng, and Tai-Yue Chang for helping with data collection. The research was funded by the Ministry of Science and Technology in Taiwan (NSC-102-2320-B-038-026; MOST 105-2320-B-038-033-MY3).