Glucose degradation products in PD fluids: Do they disappear from the peritoneal cavity and enter the systemic circulation?

Zeier, Martin; Schwenger, Vedat; Deppisch, Reinhold; Haug, Ulrike; Weigel, K; Bahner, Udo; Wanner, Christoph; Schneider, Hermann; Henle, Thomas; Ritz, Eberhard

doi:10.1046/j.1523-1755.2003.00705.x

Cited by 161 publications

(159 citation statements)

References 16 publications

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“…25 This could lead to a reduction in the systemic load of advanced glycation end products, which have been shown to exert direct proinflammatory, proapoptotic, and pro-oxidative nephrotoxicity. 26 Because biocompatible solutions are quite variable with respect to their GDP content, such heterogeneity might explain potentially conflicting trial results.…”

Section: Discussionmentioning

confidence: 99%

Effects of Biocompatible versus Standard Fluid on Peritoneal Dialysis Outcomes

Johnson

Brown

Clarke³

et al. 2012

Journal of the American Society of Nephrology

188

215

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Section: Discussionmentioning

confidence: 99%

Effects of Biocompatible versus Standard Fluid on Peritoneal Dialysis Outcomes

Johnson

Brown

Clarke³

et al. 2012

Journal of the American Society of Nephrology

188

215

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“…In addition to GDPs, AGEs formed when glucose is heated are considered to contribute to the toxicity of peritoneal dialysate (22). The GDPs and AGEs may damage peritoneal cells and proteins through various mechanisms (22)(23)(24)(25)(26)(27)(28), leading to peritoneal damage. It has become increasingly clear that, in animal models of PD, the more-biocompatible peritoneal dialysates (bicarbonate/lactate buffer, low GDPs) induce less damage and less impairment of ultrafiltration (16,19,29,30).…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

Ayuzawa¹,

Ishibashi

Takazawa³

et al. 2012

Perit Dial Int

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♦ Background: Morphology changes of the peritoneal membrane after long-term peritoneal dialysis (PD) consist of denudation of peritoneal mesothelial cells, interstitial sclerosis, and hyalinizing vasculopathy. Those changes are considered to be the result of uremia and bioincompatible effects of conventional acidic lactate-buffered dialysate with glucose degradation products (GDPs). In the last decade, biocompatible dialysate with neutral pH and low GDPs has become widely used. Clinical practice has been modified in Japan, especially for anuric patients, and now includes the use of hybrid therapy. The impact on peritoneal morphology has not been well reported. ♦ Objective: The aim of the present study was to investigate the long-term effect on peritoneal morphology and function of biocompatible fluid use and current clinical practice in Japan, including hybrid dialysis therapy. ♦ Methods: We evaluated peritoneal biopsy specimens from patients who had undergone PD for more than 3 years. We used the average peritoneal thickness (APT) of the submesothelial compact zone as a marker of interstitial sclerosis and the lumen/vessel diameter ratio (L/V ratio) at postcapillary venules as a marker of hyalinizing vasculopathy. Demography and other data for the patients, including dialysate-to-plasma (D/P) ratio of creatinine, were obtained at baseline and every 6 months by peritoneal equilibration test.

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“…During PD, GDPs EFFECT OF LOW-GDP SOLUTION ON UF AND SOLUTE TRANSPORT also may be absorbed through the peritoneal membrane into the systemic circulation, promoting apoptosis in the renal tubular epithelial cells (24). Several studies have suggested that, by reduction of GDPs and advanced glycation end-products in the systemic circulation, low-GDP solution better preserves RRF in continuous ambulatory PD patients (18,25,26). Excessive UF also may play a causative role in the decline of RRF by provoking intravascular volume depletion (27,28).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Low-GDP Solution on Ultrafiltration and Solute Transport in Continuous Ambulatory Peritoneal Dialysis Patients

Cho

Park

et al. 2013

Perit Dial Int

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♦ Background: Several studies have reported benefits for human peritoneal mesothelial cell function of a neutralpH dialysate low in glucose degradation products (GDPs). However, the effects of low-GDP solution on ultrafiltration (UF), transport of solutes, and control of body water remain elusive. We therefore investigated the effect of low-GDP solution on UF, solute transport, and control of body water. ♦ Methods: Among 79 new continuous ambulatory peritoneal dialysis (CAPD) patients, 60 completed a 12-month protocol (28 in a lactate-based high-GDP solution group, 32 in a lactate-based low-GDP solution group). Clinical indices-including 24-hour UF volume (UFV), 24-hour urine volume (UV), residual renal function, and dialysis adequacy-were measured at months 1, 6, and 12. At months 1, 6, and 12, UFV, glucose absorption, 4-hour dialysate-to-plasma (D/P) creatinine, and 1-hour D/P Na + were assessed during a modified 4.25% peritoneal equilibration test (PET). Body composition by bioelectric impedance analysis was measured at months 1 and 12 in 26 CAPD patients. ♦ Results: Daily UFV was lower in the low-GDP group. Despite similar solute transport and aquaporin function, the low-GDP group also showed lower UFV and higher glucose absorption during the PET. Factors associated with UFV during the PET were lactate-based high-GDP solution and 1-hour D/P Na + . No differences in volume status and obesity at month 12 were observed, and improvements in hypervolemia were equal in both groups. ♦ Conclusions: Compared with the high-GDP group, the low-GDP group had a lower UFV during a PET and a lower daily UFV during the first year after peritoneal dialysis initiation. Although the low-GDP group had a lower daily UFV, no difficulties in controlling edema were encountered.

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Glucose degradation products in PD fluids: Do they disappear from the peritoneal cavity and enter the systemic circulation?

Abstract: Conventional PD fluid undergoes modifications during intraperitoneal dwell with a loss of AGE forming capacity, suggesting breakdown, precipitation or resorption of GDP in vivo. This is accompanied by an increase in plasma AGE compounds.

Cited by 161 publications

References 16 publications

Effects of Biocompatible versus Standard Fluid on Peritoneal Dialysis Outcomes

Effects of Biocompatible versus Standard Fluid on Peritoneal Dialysis Outcomes

Peritoneal Morphology after Long-Term Peritoneal Dialysis with Biocompatible Fluid: Recent Clinical Practice in Japan

The Effect of Low-GDP Solution on Ultrafiltration and Solute Transport in Continuous Ambulatory Peritoneal Dialysis Patients

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