BMC Cardiovascular Disorders (Mar 2025)
Effect of limb ischemic preconditioning on the indirect index of insulin resistance in maintenance hemodialysis patients
Abstract
Abstract Background Poor prognosis of maintenance hemodialysis (MHD) patients, including cardiovascular disease (CVD) and protein-energy wasting (PEW), is strongly associated with insulin resistance (IR). Previous studies have revealed that limb ischemic preconditioning (LIPC), as an intervention, is effective in reducing inflammation and oxidative stress levels in patients. The aim of this study was to elucidate the effects of LIPC on IR indirect indices, inflammation and oxidative stress indices, and to further explore the potential mechanisms of LIPC in reducing IR indices. Methods A retrospective analysis was performed on 62 patients with MHD who had previously undergone limb ischemia preconditioning (LIPC) or sham surgery (Sham). General clinical and laboratory data were collected. Furthermore, to assess the IR status of MHD patients, the following indices were employed: triglyceride-glucose index (TyG), triglyceride-glucose body mass index (TyG-BMI), triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C), and metabolic score of insulin resistance (METS-IR). Inflammation and oxidative stress indicators included high-sensitivity C-reactive protein (hs-CRP), hs-CRP /albumin ratio (CAR), serum malondialdehyde (MDA) and superoxide dismutase (SOD). Mediation analysis was conducted using Model 4 in the SPSS PROCESS macro version 4.1. Results Following a four-week experiment, hs-CRP (15.46 ± 3.60 vs. 10.53 ± 5.42, p < 0.001), CAR (0.39 ± 0.10 vs. 0.26 ± 0.13, p < 0.001) and MDA (8.46(6.71,9.85) vs. 5.99(5.11,7.89), p = 0.001) indices were significantly decreased in the MHD patients of the LIPC group, whereas SOD indices (215.07(180.27,286.45) vs. 267.76(228.32,319.54), p = 0.012) were significantly higher. Only hs-CRP (-4.93 ± 5.68 vs. 0.16 ± 5.39, p = 0.001) and CAR (-0.14 ± 0.14 vs. -0.001 ± 0.15, p = 0.001) were significantly different in the LIPC group compared to the Sham group. In contrast, the changes in MDA (p = 0.058) and SOD (p = 0.107) were not statistically significant between groups. The intra- and inter-group differences in the four indirect indices of IR were significant (p < 0.05). The heatmap revealed a notable correlation between the changes in hs-CRP and CAR levels and the changes in the IR indirect indices. In addition, The mediation model showed that the inflammatory indicators hs-CRP played a partial mediating role in the improvement of IR indices (TyG-BMI) by LIPC. Conclusion LIPC has an excellent ability to inhibit inflammation and peroxidation. In addition, in MHD patients, inflammation plays a significant role in the process of LIPC improving IR index.
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