title: "NEPP" peritoneal dialysis regimen has beneficial effects on plasma CEL and 3-DG, but not pentosidine, CML, and MGO.
abstract: BACKGROUND
  Standard peritoneal dialysis (PD) solutions contain high levels of glucose and glucose degradation products (GDPs), both contributing to the formation of advanced glycation end products (AGEs). We studied the contribution to plasma GDP and AGE levels of 2 PD regimens that differ in glucose and GDP loads: high load [standard PD (sPD) using 4 glucose-lactate exchanges] and low load [1 amino acid exchange, 1 icodextrin exchange, and 2 glucose-bicarbonate/lactate exchanges ("NEPP")].
  
  
  METHODS
  In a prospective crossover study (2 periods of 24 weeks), new continuous ambulatory PD patients were randomized to NEPP-sPD (n = 23) or to sPD-NEPP (n = 27).
  
  
  RESULTS
  After the start of PD, absolute increases were observed in plasma levels of 3-deoxyglucosone (3-DG, 220.4 nmol/L, p < 0.0001) and in N(ε)-(carboxymethyl) lysine (CML) in plasma proteins (0.02 μmol/L CML per 1 mol/L lysine, p < 0.0001). During the first 6 weeks, 3-DG tended to increase more with sPD treatment (p = 0.08), and CML, with NEPP treatment (p = 0.002). In both groups, N(ε)-(carboxyethyl)lysine (CEL) in plasma proteins declined significantly with the start of PD. Treatment with NEPP resulted in higher levels of methylglyoxal (MGO) and lower levels of 3-DG and CEL. Pentosidine in the albumin fraction tended to increase less during NEPP treatment.
  
  
  CONCLUSIONS
  A low glucose and GDP PD regimen (NEPP) resulted in plasma levels of 3-DG and CEL that were lower than those with a glucose-based sPD regimen. Starting PD with NEPP was associated with a steeper increase in CML, and continuing treatment with NEPP resulted in higher MGO levels.
authors.affiliation: Department of Internal Medicine, Red Cross Hospital, The Hague, the Netherlands.
authors.forename: Caatje Y
authors.initials: CY
authors.lastname: le Poole
authors.forename: Frans J
authors.initials: FJ
authors.lastname: van Ittersum
authors.forename: Rob M
authors.initials: RM
authors.lastname: Valentijn
authors.forename: Tom
authors.initials: T
authors.lastname: Teerlink
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Piet M
authors.initials: PM
authors.lastname: Ter Wee
authors.forename: Casper G
authors.initials: CG
authors.lastname: Schalkwijk
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D001639:Bicarbonates / Q000494:pharmacology; D002851:Chromatography, High Pressure Liquid; D018592:Cross-Over Studies; D003847:Deoxyglucose / Q000031:analogs & derivatives* / Q000097:blood; D015314:Dialysis Solutions / Q000494:pharmacology*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D005936:Glucans / Q000494:pharmacology; D005947:Glucose / Q000494:pharmacology; D017127:Glycation End Products, Advanced; D006801:Humans; D000077607:Icodextrin; D007773:Lactates / Q000494:pharmacology; D008239:Lysine / Q000031:analogs & derivatives* / Q000097:blood; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010537:Peritoneum; D011446:Prospective Studies; D011765:Pyruvaldehyde / Q000097:blood
chemical_list: D001639:Bicarbonates; D015314:Dialysis Solutions; D004338:Drug Combinations; D005936:Glucans; D017127:Glycation End Products, Advanced; D007773:Lactates; D000077607:Icodextrin; C048496:N(6)-carboxymethyllysine; D011765:Pyruvaldehyde; D001120:Arginine; D003847:Deoxyglucose; C062187:pentosidine; C016350:3-deoxyglucosone; D005947:Glucose; D008239:Lysine