Does Glucose in Dialysis Fluid Protect Erythrocytes in Patients with Chronic Renal Failure?

Abstract

Background/Aims: The aim of this study was to assess the multifaceted influence of glucose present in dialyzing fluid on erythrocytes of patients with chronic renal failure (CRF) undergoing regular hemodialysis. Methods: A group of 44 subjects with CRF undergoing regular hemodialysis was studied. Two tests were used: osmotic fragility and resistance to the hemolytic agent saponin. The total content of isoprostane 8-iso-prostaglandin F₂α type III (8-iPF₂α-III) in plasma and erythrocyte’s membrane were determined by the ELISA method. Results: The presence of glucose in the dialysate is associated with lower intravascular hemolysis markers and high total 8-iPF₂α-III concentrations in plasma. Conclusion: The presence of glucose in dialyzing fluid could protect erythrocytes. It limits hemolysis in patients with CRF, but, on the other hand, increases the oxidative processes. This kind of treatment along with other therapeutic intervention such as administration of antioxidants (e.g. α-tocopherol, ascorbic acid, N-acetylcysteine) could improve the condition of erythrocytes and outcome in CRF.

Prooxidative-Antioxidative Balance of Cells in Different Types of Renal Replacement Therapy

“…Other authors also showed that the activity of G6PDH depends on the glucose content in the dialysate. The activity was the highest in the presence of glucose [41,42,43]. …”

One Man’s Meat and Another’s Poison: Adding Glucose in Dialysis Fluid

“…Serial studies from Dolegowska's group have focused on the role of glucose and the protective effects of erythrocytes on oxidative stress in the HD population [7][8][9][10] . In this issue [11] , they demonstrated further that glucose present in dialysate could conserve erythrocyte membrane integrity and limit possible hemolysis induced by the HD process. Such observations may bring high clinical implications and deserve further discussions.…”

“…The HMP pathway can provide reducing equivalents and actively increase antioxidant glutathione (GSH) synthesis during HD therapy. Therefore, the risk of hemolysis induced by HD can be reduced by adding glucose in dialysis fluid [11] . However, superoxide production during hypoglycemic status is primarily by NADPH oxidase [15] .…”

“…And it is the GSH level and rate of ROS elimination that determine oxidative damage [14] and the risk of hemolysis during HD [16] . The work of Dolegowska et al [11] would be grander if they performed a mechanism study.…”

“…Finally, the work by Dolegowska et al [11] implicated that physiological concentration of glucose added in HD fluid is beneficial, at least for preservation of erythrocyte integrity and prevention of hemolysis during HD process. Could this concept be extended to peritoneal dialysis (PD) therapy in patients who are exposed to a higher level of glucose intraperitoneally and have to bear treatment for a longer duration?…”