使用无糖或含糖透析液进行血液透析时的皮肤和血浆自体荧光。

Skin- and Plasmaautofluorescence in hemodialysis with glucose-free or glucose-containing dialysate.

作者信息

Ramsauer Bernd, Engels Gerwin Erik, Graaff Reindert, Sikole Aleksandar, Arsov Stefan, Stegmayr Bernd

机构信息

Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden.

Department of Nephrology, Skaraborgs Hospital, 541 58, Skövde, Sweden.

出版信息

BMC Nephrol. 2017 Jan 5;18(1):5. doi: 10.1186/s12882-016-0418-0.

DOI:10.1186/s12882-016-0418-0

PMID:28056864

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5217331/

Abstract

BACKGROUND

Haemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD). Skin autofluorescence (SAF) is a strong marker for CVD. SAF indirectly measures tissue advanced glycation end products (AGE) being cumulative metabolites of oxidative stress and cytokine-driven inflammatory reactions. The dialysates often contain glucose.

METHODS

Autofluorescence of skin and plasma (PAF) were measured in patients on HD during standard treatment (ST) with a glucose-containing dialysate (n = 24). After that the patients were switched to a glucose-free dialysate (GFD) for a 2-week period. New measurements were performed on PAF and SAF after 1 week (M1) and 2 weeks (M2) using GFD. Nonparametric paired statistical analyses were performed between each two periods.

RESULTS

SAF after HD increased non-significantly by 1.2% while when a GFD was used during HD at M1, a decrease of SAF by 5.2% (p = 0.002) was found. One week later (M2) the reduction of 1.6% after the HD was not significant (p = 0.33). PAF was significantly reduced during all HD sessions. Free and protein-bound PAF decreased similarly whether glucose containing or GFD was used. The HD resulted in a reduction of the total PAF of approximately 15%, the free compound of 20% and the protein bound of 10%. The protein bound part of PAF corresponded to approximately 56% of the total reduction. The protein bound concentrations after each HD showed the lowest value after 2 weeks using glucose-free dialysate (p < 0.05). The change in SAF could not be related to a change in PAF.

CONCLUSIONS

When changing to a GFD, SAF was reduced by HD indicating that such measure may hamper the accumulation and progression of deposits of AGEs to protein in tissue, and thereby also the development of CVD. Glucose-free dialysate needs further attention. Protein binding seems firm but not irreversible.

TRIAL REGISTRATION

ISRCTN registry: ISRCTN13837553 . Registered 16/11/2016 (retrospectively registered).

摘要

背景

血液透析（HD）患者患心血管疾病（CVD）的风险增加。皮肤自发荧光（SAF）是CVD的一个重要标志物。SAF间接测量组织晚期糖基化终产物（AGE），AGE是氧化应激和细胞因子驱动的炎症反应的累积代谢产物。透析液中通常含有葡萄糖。

方法

对24例接受含葡萄糖透析液标准治疗（ST）的HD患者测量皮肤和血浆自发荧光（PAF）。之后，患者改用无糖透析液（GFD），为期2周。在使用GFD 1周（M1）和2周（M2）后，对PAF和SAF进行新的测量。对每两个时期进行非参数配对统计分析。

结果

HD后SAF无显著增加，增加了1.2%，而在M1期HD期间使用GFD时，SAF下降了5.2%（p = 0.002）。1周后（M2），HD后下降1.6%不显著（p = 0.33）。在所有HD治疗期间，PAF均显著降低。无论使用含葡萄糖的透析液还是GFD，游离和与蛋白结合的PAF下降情况相似。HD使总PAF降低约15%，游离化合物降低20%，与蛋白结合的降低10%。PAF与蛋白结合部分约占总降低量的56%。使用无糖透析液2周后，每次HD后与蛋白结合的浓度显示出最低值（p < 0.05）。SAF的变化与PAF的变化无关。