Ho-dac-Pannekeet M M, Weiss M F, de Waart D R, Erhard P, Hiralall J K, Krediet R T
Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
Perit Dial Int. 1999;19 Suppl 2:S68-74.
Glucose-containing dialysis solutions in peritoneal dialysis (PD) patients induce non enzymatic glycosylation (NEG) within the peritoneal cavity. The subsequent formation of advanced glycosylation end-products (AGEs) may be implicated in the functional deterioration of the peritoneal membrane in long-term PD patients. AIM OF THE STUDY AND PARAMETERS: Measurement of NEG by the determination of percent glycation of albumin and IgG (GP), and of AGEs by measuring pentosidine content of protein in 4-hour effluents (Peff) and serum.
In 5 patients each, a comparison was made between 3.86% glucose and 1.36% glucose (GP and Peff), and between 3.86% glucose and 7.5% icodextrin (Peff). Nine patients with clinically severe ultrafiltration failure (UFF) were compared to nine patients treated with PD for 1 month. Six of the patients with UFF were treated with non glucose dialysis solutions and Peff was studied again after 6 weeks.
No difference was found between Peff comparing 3.86% glucose to either 1.36% glucose or icodextrin. GP were higher in 3.86% glucose than in 1.36%. Glycated/non glycated (G/NG) protein clearance ratios were 1.29 for albumin and 1.12 for IgG (p = 0.003). In contrast to GP, both Peff and serum pentosidine were higher in the UFF patients than in the recently started patients. Peff, but not GP, correlated with duration of PD (r = 0.67, p = 0.04). In 5 of 6 patients treated with non glucose dialysate, Peff decreased while serum pentosidine was stable.
These data show that 4-hour Peff contents are not influenced by glucose concentration or osmolality, in contrast to GP. The relation between Peff and duration of PD, and the effect of non glucose dialysate on Peff, suggest that long-term glucose exposure is an important determinant of membrane glycosylation. Thus Peff probably reflects the long-term effects of intraperitoneal glycosylation of peritoneal membrane proteins. Treatment with non glucose dialysis solutions may result in "washout" of glycosylated proteins from the peritoneal membrane.
腹膜透析（PD）患者使用含葡萄糖的透析液会在腹腔内引发非酶糖基化（NEG）。晚期糖基化终产物（AGEs）的后续形成可能与长期PD患者腹膜功能恶化有关。研究目的及参数：通过测定白蛋白和IgG的糖化百分比（GP）来测量NEG，通过测量4小时流出液（Peff）和血清中蛋白质的戊糖苷含量来测量AGEs。
每组5例患者，比较3.86%葡萄糖与1.36%葡萄糖（GP和Peff），以及3.86%葡萄糖与7.5%艾考糊精（Peff）之间的差异。将9例临床严重超滤失败（UFF）患者与9例接受PD治疗1个月的患者进行比较。6例UFF患者接受非葡萄糖透析液治疗，6周后再次研究Peff。
比较3.86%葡萄糖与1.36%葡萄糖或艾考糊精时，Peff未发现差异。3.86%葡萄糖组的GP高于1.36%葡萄糖组。白蛋白的糖化/非糖化（G/NG）蛋白清除率为1.29，IgG为1.12（p = 0.003）。与GP相反，UFF患者的Peff和血清戊糖苷均高于近期开始治疗的患者。Peff与PD持续时间相关（r = 0.67，p = 0.04），而GP无此相关性。6例接受非葡萄糖透析液治疗的患者中，5例Peff降低，而血清戊糖苷稳定。
这些数据表明，与GP不同，4小时Peff含量不受葡萄糖浓度或渗透压的影响。Peff与PD持续时间的关系以及非葡萄糖透析液对Peff的影响表明，长期葡萄糖暴露是膜糖基化的重要决定因素。因此，Peff可能反映了腹膜蛋白腹腔内糖基化的长期影响。使用非葡萄糖透析液治疗可能会使腹膜膜上的糖基化蛋白“洗脱”。
