Uremia Clinical Trial
Official title:
Elimination and Biodegradation of the Incretin Hormones GLP-1 and GIP in Patients With End-stage Renal Disease
The prevalence of type 2 diabetes (T2D) is increasing rapidly worldwide. T2D is
characterized by a severely impaired incretin effect. The incretin effect refers to the
insulinotropic action of the nutrient-released incretin hormones glucagon-like peptide-1
(GLP-1) and glucose-dependent insulinotropic peptide (GIP). The incretin effect is defined
as the difference in insulin secretory responses between oral and isoglycaemic intravenous
glucose challenges (OGTT and IIGI, respectively) and in healthy individuals it accounts for
as much as 70% of the insulin response following oral glucose, whereas patients with T2D
exhibit an incretin effect in the range of 0 to 30%. Patients with T2D and non-diabetic
patients with severe kidney failure share several pathophysiological characteristics,
including decreased insulin sensitivity, fasting hyperinsulinaemia and impaired beta-cell
function. The reason for these findings remains to be fully elucidated. An ongoing study in
our research group is investigating the incretin effect and the incretin hormone secretory
responses following OGTT, IIGI and meal ingestion, respectively. In continuation of this
study, essential knowledge of metabolism of incretin hormones in an uremic milieu will be
obtained in the present study prior to evaluation of the use of incretin-based agents in
patients with impaired kidney function. In this second study we evaluate the elimination and
biodegradation of GLP-1 and GIP. The biological active incretin hormones are rapidly
degraded by the ubiquitous enzyme dipeptidyl peptidase-4 (DPP-4), generating inactive
metabolites. The active hormones are however also eliminated by renal clearance, although
the importance of this remains questionable. It is likely that the degradation and
elimination of the active hormones will be significantly affected in patients with severe
kidney impairment.
We hypothesize that elimination and biodegradation of the two incretin hormones, both in
it´s active and inactive forms, will be affected in non-diabetic patients with severe kidney
failure.
n/a
Observational Model: Case Control, Time Perspective: Cross-Sectional
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