使用艾考糊精进行腹膜透析时的氨基甲酰化白蛋白和晚期糖基化终产物形成

Amadori albumin and advanced glycation end-product formation in peritoneal dialysis using icodextrin.

作者信息

Posthuma N, ter Wee P M, Niessen H, Donker A J, Verbrugh H A, Schalkwijk C G

机构信息

Department of Nephrology, Institute of Cardiovascular Research, Free University Hospital Amsterdam, The Netherlands.

出版信息

Perit Dial Int. 2001 Jan-Feb;21(1):43-51.

PMID:11280495

Abstract

OBJECTIVE

To study the influence of peritoneal dialysis (PD) solutions on the formation of early glycated products and advanced glycation end-products (AGEs).

DESIGN AND PATIENTS

The formation of both Amadori albumin and AGEs in glucose- and icodextrin-based PD fluids was analyzed in vitro and in peritoneal effluents of continuous cyclic peritoneal dialysis (CCPD) patients.

RESULTS

Albumin incubated with glucose-based PD fluids showed a time- and glucose concentration-dependent formation of Amadori albumin and AGEs. Aminoguanidine completely inhibited AGE but not Amadori albumin formation. Albumin incubated in icodextrin resulted in the lowest levels of Amadori albumin and AGE. Amadori albumin levels in effluents of 24 CCPD patients (12 glucose and 12 icodextrin for their daytime dwells) were similar. Dialysate samples collected during a mass transfer area coefficient test in 16 CCPD patients (8 glucose, 8 icodextrin) showed an increase in Amadori albumin formation from baseline (p < 0.0001), without a difference between the groups. In the total group, there was a positive relationship between duration on PD and dialysate Amadori albumin concentration at 240 minutes (p = 0.03). The Amadori albumin dialysate-to-plasma (D/P) ratio at 240 minutes was 0.82+/-0.11, and its clearance amounted to 7.71+/-1.14 mL/min, while the albumin D/P ratio was 0.010+/-0.003 and its clearance was 0.089+/-0.017 mL/min. In a peritoneal biopsy of a CCPD patient, Amadori albumin was observed in the mesothelial layer and the endothelium of the peritoneum.

CONCLUSIONS

Using icodextrin-based instead of glucose-based PD fluids can largely reduce the formation of Amadori albumin and AGEs. However, CCPD patients using icodextrin during daytime dwells do not have lower effluent levels of Amadori albumin and AGEs, probably due to the exposure to glucose during their nighttime exchanges. Kinetic studies suggest washout of locally produced Amadori albumin.

摘要

目的

研究腹膜透析（PD）液对早期糖基化产物和晚期糖基化终末产物（AGEs）形成的影响。

设计与患者

对基于葡萄糖和艾考糊精的腹膜透析液中阿马多里白蛋白和AGEs的形成进行了体外分析，并分析了持续循环腹膜透析（CCPD）患者的腹膜流出液情况。

结果

与基于葡萄糖的腹膜透析液孵育的白蛋白显示出阿马多里白蛋白和AGEs的形成呈时间和葡萄糖浓度依赖性。氨基胍完全抑制AGEs的形成，但不抑制阿马多里白蛋白的形成。在艾考糊精中孵育的白蛋白导致阿马多里白蛋白和AGEs的水平最低。24例CCPD患者（白天留腹时12例使用葡萄糖透析液，12例使用艾考糊精透析液）流出液中的阿马多里白蛋白水平相似。在16例CCPD患者（8例使用葡萄糖透析液，8例使用艾考糊精透析液）的传质面积系数测试期间收集的透析液样本显示，阿马多里白蛋白的形成较基线水平增加（p<0.0001），两组之间无差异。在整个研究组中，腹膜透析持续时间与240分钟时透析液中阿马多里白蛋白浓度呈正相关（p = 0.03）。240分钟时阿马多里白蛋白的透析液与血浆（D/P）比值为0.82±0.11,其清除率为7.71±1.14 mL/min，而白蛋白的D/P比值为0.010±0.003，其清除率为0.089±0.017 mL/min。在一名CCPD患者的腹膜活检中，在间皮细胞层和腹膜内皮中观察到了阿马多里白蛋白。