title: Take care in how you store your PD fluids: actual temperature determines the balance between reactive and non-reactive GDPs.
abstract: OBJECTIVE
  During heat sterilization and during prolonged storage, glucose in peritoneal dialysis fluids (PDF) degrades to carbonyl compounds commonly known as glucose degradation products (GDPs). Of these, 3,4-dideoxyglucosone-3-ene (3,4-DGE) is the most cytotoxic. It is an intermediate in degradation between 3-deoxyglucosone (3-DG) and 5-hydroxymethyl-2-furaldehyde (5-HMF). We have earlier reported that there seems to be equilibrium between these GDPs in PDF. The aim of the present study was to investigate details of this equilibrium.
  
  
  METHODS
  Aqueous solutions of pure 3-DG, 3,4-DGE, and 5-HMF were incubated at 40 degrees C for 40 days. Conventional and low-GDP fluids were incubated at various temperatures for up to 3 weeks. Formaldehyde, acetaldehyde, glyoxal, methylglyoxal, 3-DG, 3,4-DGE, and 5-HMF were analyzed using high performance liquid chromatography.
  
  
  RESULTS
  Incubation of 100 micromol/L 3,4-DGE resulted in the production of 36 micromol/L 3-DG, 4 micromol/L 5-HMF, and 40 micromol/L unidentified substances. With the same incubation, 200 micromol/L 3-DG was converted to 9 micromol/L 3,4-DGE, 6 micromol/L 5-HMF, and 14 micromol/L unidentified substances. By contrast, 100 micromol/L 5-HMF was uninfLuenced byincubation. In a conventional PDF incubated at 60 degrees C for 1 day, the 3,4-DGE concentration increased from 14 to a maximum of 49 micromol/L. When the fluids were returned to room temperature, the concentration decreased but did not reach original values until after 40 days. In a low GDP fluid, 3,4-DGE increased and decreased in the same manner as in the conventional fluid but reached a maximum of only 0.8 micromol/L.
  
  
  CONCLUSIONS
  Considerable amounts of 3,4-DGE may be recruited by increases in temperature in conventional PDFs. Lowering the temperature will again reduce the concentration but much more time will be needed. Precursors for 3,4-DGE recruitment are most probably 3-DG and the enol 3-deoxyaldose-2-ene, but not 5-HMF. Considering the ease at which 3,4-DGE is recruited from its pool of precursors and the difficulty of getting rid of it again, one should be extremely careful with the temperatures conventional PDFs are exposed to.
authors.affiliation: Corporate Research, Gambro AB, Lund, Sweden. martin.erixon@gambro.com
authors.forename: Martin
authors.initials: M
authors.lastname: Erixon
authors.forename: Anders
authors.initials: A
authors.lastname: Wieslander
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Lindén
authors.forename: Ola
authors.initials: O
authors.lastname: Carlsson
authors.forename: Gunita
authors.initials: G
authors.lastname: Forsbäck
authors.forename: Eva
authors.initials: E
authors.lastname: Svensson
authors.forename: Jan Ake
authors.initials: JA
authors.lastname: Jönsson
authors.forename: Per
authors.initials: P
authors.lastname: Kjellstrand
mesh_terms: D000818:Animals; D002452:Cell Count; D002478:Cells, Cultured; D002851:Chromatography, High Pressure Liquid; D003847:Deoxyglucose / Q000031:analogs & derivatives* / Q000032:analysis; D015314:Dialysis Solutions / Q000737:chemistry*; D004356:Drug Storage / Q000379:methods; D005347:Fibroblasts / Q000166:cytology / Q000187:drug effects; D005662:Furaldehyde / Q000031:analogs & derivatives* / Q000032:analysis; D005947:Glucose / Q000032:analysis*; D024981:Glycogen Phosphorylase / Q000037:antagonists & inhibitors; D006358:Hot Temperature; D066298:In Vitro Techniques; D051379:Mice; D010530:Peritoneal Dialysis; D011753:Pyrones / Q000032:analysis*
chemical_list: C504711:3,4-dideoxyglucosone-3-ene; D015314:Dialysis Solutions; D011753:Pyrones; C008046:5-hydroxymethylfurfural; D003847:Deoxyglucose; D005662:Furaldehyde; D024981:Glycogen Phosphorylase; C016350:3-deoxyglucosone; D005947:Glucose