Ultrafiltration Characteristics of Glucose Polymers with Low Polydispersity

Leypoldt, John K.; Hoff, Catherine M.; Piscopo, Dean; Carr, Seraya N.; Svatek, Jessica; Holmes, Clifford J.

doi:10.3747/pdi.2012.00009

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…In contrast, compared with 7.5% icodextrin, 7.5% 19 kDa glucose polymer of low polydispersity achieved both lower net UF and lower carbohydrate absorption. These theoretical results are qualitatively comparable to those we reported previously based on experiments in a rabbit model (9). Decreasing the polydispersity of either glucose polymer without altering the weight-average molecular weight had a minor effect on net UF, but resulted in substantially lower carbohydrate absorption.…”

Section: Resultssupporting

confidence: 92%

“…Our experimental results were obtained in a rabbit model that we have previously used to study glucose polymer osmotic agents (9). The current experiments were similar in design, except that the dwell was extended to 8 hours from 4 hours.…”

Section: Discussionmentioning

confidence: 99%

“…We recently showed that rabbits can be used as experimental subjects for evaluating glucose polymers with low polydispersity as osmotic agents for PD solutions (9). In that study, we demonstrated that a low molecular weight (6 kDa) glucose polymer was more effective at generating UF and had a higher UF efficiency than a high molecular weight (19 kDa) glucose polymer when tested at the same concentration (7.5%).…”

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confidence: 99%

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Low-Polydispersity Glucose Polymers as Osmotic Agents for Peritoneal Dialysis

et al. 2015

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♦ Background: Peritoneal dialysis (PD) solutions containing icodextrin as the osmotic agent have advantages during long dwells. The glucose polymers that constitute icodextrin are a heterogeneous mix of molecules with a polydispersity [ratio of weight-average to number-average molecular weight (Mw/Mn)] of approximately 2.6. The present study evaluates whether modifications in the polydispersity and concentration of glucose polymers can improve ultrafiltration (UF) without an associated increase in carbohydrate absorption (CA). ♦ Methods: Computer simulations using a three-pore model of peritoneal transport during a long dwell in PD patients predict that, in general, compared with 7.5% icodextrin, glucose polymers with a Mw greater than or equal to 7.5 kDa, a polydispersity less than 2.6, and concentrations greater than 7% could achieve higher UF without higher CA. Based on the simulations, we hypothesized that, compared with 7.5% icodextrin, glucose polymers with a Mw of 18 -19 kDa and a polydispersity of 2.0 at 11% concentration could achieve higher UF without a higher CA. We tested this hypothesis in experimental studies using 8-hour dwells in New Zealand White rabbits. In those studies, UF was measured by complete fluid collection, and CA was measured by subtracting the total carbohydrate in the collected fluid from the carbohydrate initially infused. ♦ Results: The UF was higher with 11% 19 kDa glucose polymer than with 7.5% icodextrin (mean ± standard deviation: 89 ± 31 mL vs 49 ± 15 mL; p = 0.004) without higher CA (5.2 ± 0.9 g vs 5.0 ± 0.9 g, p = 0.7). Similar results were seen with the 11% 18 kDa glucose polymer, which, compared with 7.5% icodextrin, resulted in higher UF (mean ± standard deviation: 96 ± 18 mL vs 66 ± 17 mL; p < 0.001) without higher CA (4.8 ± 0.7 g vs 5.2 ± 0.6 g, p = 0.2).

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Section: Resultssupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Low-Polydispersity Glucose Polymers as Osmotic Agents for Peritoneal Dialysis

et al. 2015

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“…8D). Ultrafiltration of the dialyzed sample revealed that the activity was contained in the .10 kDa fraction, suggesting that the relatively imperfect molecular cutoff of dialysis bags [40] allowed larger, active molecules to leak into the DLE. The DLE preparation was evaluated for cytokine contamination and found to be negative for IFN-g, IL-1a, IL-1b, IL-2, IL-4, IL-5, IL-6, IL-10, IL-12, IL-13, IL-17A, and TNF-a (not shown).…”

Section: The Active Fraction Of Dle Does Not Contain Antigen Contaminmentioning

confidence: 99%

CD8+ T cells produce a dialyzable antigen-specific activator of dendritic cells

Myles

Zhao

Nardone

et al. 2016

Journal of Leukocyte Biology

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Cellular lysates from PPD donors have been reported to transfer tuberculin reactivity to naïve recipients, but not diphtheria reactivity, and vice versa. A historically controversial topic, the terms "transfer factor" and "DLE" were used to characterize the reactivity-transferring properties of lysates. Intrigued by these reported phenomena, we found that the cellular extract derived from antigen-specific memory CD8 T cells induces IL-6 from antigen-matched APCs. This ultimately elicits IL-17 from bystander memory CD8 T cells. We have identified that dialyzable peptide sequences, S100a9, and the TCR β chain from CD8 T cells contribute to the molecular nature of this activity. We further show that extracts from antigen-targeted T cells enhance immunity to Staphylococcus aureus and Candida albicans These effects are sensitive to immunization protocols and extraction methodology in ways that may explain past discrepancies in the reproducibility of passive cellular immunity.

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“…The polydispersity for icodextrin is reported to be 2.6. 130 Using the three-pore model for theoretical calculations, investigators evaluated the use of glucose polymers with low polydispersity in rabbit models. They were able to show long-dwell PD fluids containing 11% 18-19 kDa glucose polymers with low polydispersity can provide higher UF without higher carbohydrate absorption.…”

Section: Polyglucose Solutionsmentioning

confidence: 99%

Peritoneal dialysis fluids

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2022

Seminars in Dialysis

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There have been significant advances in the understanding of peritoneal dialysis (PD) in the last 40 years, and uptake of PD as a modality of kidney replacement therapy is increasing worldwide. PD fluids, therefore, remains the lifeline for patients on this treatment. Developing these fluids to be efficacious in solute clearance and ultrafiltration, with minimal adverse consequences to peritoneal membrane health and systemic effects is a key requirement. Since the first PD fluid produced in 1959, modifications to PD fluids have been made. Nonetheless, the search for that ideal PD fluid remains elusive. Understanding the components of PD fluids is a key aspect of optimizing the successful delivery of PD, allowing for individualized PD prescription. Glucose remains an integral component of PD fluids; however, its deleterious effects continue to be the impetus for the search of an alternative osmotic agent, and icodextrin remains the main alternative. More biocompatible PD fluids have been developed and have shown benefits in preserving residual kidney function. However, high cost and reduced accessibility remain deterrents to its widespread clinical use in many countries. Large‐scale clinical trials are necessary and very much awaited to improve the narrow spectrum of PD fluids available for clinical use.

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Ultrafiltration Characteristics of Glucose Polymers with Low Polydispersity

Abstract: Glucose polymers with low polydispersity are effective osmotic agents in a rabbit model. The low-Mw polymer was more effective at generating UF and had a higher UF efficiency, but those results came at the expense of the polymer being more readily absorbed from the peritoneal cavity.

Cited by 6 publications

References 26 publications

Low-Polydispersity Glucose Polymers as Osmotic Agents for Peritoneal Dialysis

Low-Polydispersity Glucose Polymers as Osmotic Agents for Peritoneal Dialysis

CD8+ T cells produce a dialyzable antigen-specific activator of dendritic cells

Peritoneal dialysis fluids

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