The influence of bicarbonate/lactate-buffered PD fluids on N{ε}-(carboxyethyl)lysine and N{ε}-(carboxymethyl)lysine in peritoneal effluent.
OBJECTIVE
Accumulation of advanced glycation end products (AGEs) may be involved in the pathogenesis of peritoneal membrane dysfunction. As glycoxidation may play an important role in AGE formation, peritoneal dialysis fluids with low levels of glucose degradation products (GDPs) might result in a reduction in AGE concentration in the peritoneal effluent. The aim of this study was to compare the effects of conventional glucose-containing dialysis solutions and low GDP level fluids on the concentration of the AGEs N(ε)-(carboxymethyl)lysine (CML) and N(ε)-(carboxyethyl)lysine (CEL) in peritoneal effluent.


METHODS
Prospective randomized control study.


METHODS
23 patients were treated with either conventional glucose-containing fluid (n = 11, group A) or low level GDP fluid (n = 12, group B) during a period of 12 weeks. Before and after this period, CML and CEL were measured in peritoneal effluent.


RESULTS
In groups A and B there were changes in CML concentrations [respectively 13.7 ± 17.0 and -16.0 ± 46.0 nmol/L (NS)] and CEL concentrations (respectively 20.3 ± 26.6 and -8.8 ± 18.9 nmol/L, p = 0.015). Residual renal function (RRF) in groups A and B was, respectively, 6.8 and 6.1 mL/min (NS). CML, but not CEL, in the peritoneal effluent was inversely related to RRF (r = -0.67, p < 0.05).


CONCLUSIONS
CEL, but not CML, in the peritoneal effluent appears to be influenced by the prescription of low GDP level fluid, probably due to the highly reduced concentration of methylglyoxal, which is needed for formation of CEL. CML is primarily influenced by RRF.
Cnossen
Trijntje T
TT
Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre (MUMC), The Netherlands.
Gladziwa
Ulrich
U
van de Kerkhof
Jos J
JJ
Schalkwijk
Casper G
CG
Scheijen
Jean
J
van Amersfoort
Jolanda
J
Moret
Karin
K
Beerenhout
Charles H
CH
Kooman
Jeroen P
JP
D001202:Ascitic Fluid / Q000737:chemistry*; D001639:Bicarbonates / Q000008:administration & dosage / Q000009:adverse effects*; D015314:Dialysis Solutions / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D007773:Lactates / Q000008:administration & dosage / Q000009:adverse effects*; D008239:Lysine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism; D010538:Peritonitis / Q000139:chemically induced / Q000378:metabolism; D011446:Prospective Studies
D001639:Bicarbonates; D015314:Dialysis Solutions; D017127:Glycation End Products, Advanced; D007773:Lactates; C054688:N(6)-(1-carboxyethyl)lysine; C048496:N(6)-carboxymethyllysine; D008239:Lysine