scholarly journals “NEPP” Peritoneal Dialysis Regimen has Beneficial Effects on Plasma Cel and 3-DG, but not Pentosidine, CML, and MGO

2012 ◽  
Vol 32 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Caatje Y. le Poole ◽  
Frans J. van Ittersum ◽  
Rob M. Valentijn ◽  
Tom Teerlink ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Levels ◽  
Plasma Proteins ◽  
Degradation Products ◽  
Beneficial Effects ◽  
Glycation End Products ◽  
Low Load ◽  
Carboxymethyl Lysine ◽  
Low Glucose ◽  
Acid Exchange

BackgroundStandard peritoneal dialysis (PD) solutions contain high levels of glucose and glucose degradation products (GDPs), both contributing to the formation of advanced glycation end products (AGEs). We studied the contribution to plasma GDP and AGE levels of 2 PD regimens that differ in glucose and GDP loads: high load [standard PD (sPD) using 4 glucose-lactate exchanges] and low load [1 amino acid exchange, 1 icodextrin exchange, and 2 glucose-bicarbonate/lactate exchanges (“NEPP”)].MethodsIn a prospective crossover study (2 periods of 24 weeks), new continuous ambulatory PD patients were randomized to NEPP-sPD ( n = 23) or to sPD-NEPP ( n = 27).ResultsAfter the start of PD, absolute increases were observed in plasma levels of 3-deoxyglucosone (3-DG, 220.4 nmol/L, p < 0.0001) and in Nε-(carboxymethyl) lysine (CML) in plasma proteins (0.02 μmol/L CML per 1 mol/L lysine, p < 0.0001). During the first 6 weeks, 3-DG tended to increase more with sPD treatment (p = 0.08), and CML, with NEPP treatment (p = 0.002). In both groups, Nε-(carboxyethyl)lysine (CEL) in plasma proteins declined significantly with the start of PD. Treatment with NEPP resulted in higher levels of methylglyoxal (MGO) and lower levels of 3-DG and CEL. Pentosidine in the albumin fraction tended to increase less during NEPP treatment.ConclusionsA low glucose and GDP PD regimen (NEPP) resulted in plasma levels of 3-DG and CEL that were lower than those with a glucose-based sPD regimen. Starting PD with NEPP was associated with a steeper increase in CML, and continuing treatment with NEPP resulted in higher MGO levels.

Can N-Acetylcysteine Preserve Peritoneal Function and Morphology in Encapsulating Peritoneal Sclerosis?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 202-205 ◽  
Author(s):  
Devrim Bozkurt ◽  
Ender Hur ◽  
Burcu Ulkuden ◽  
Murat Sezak ◽  
Hasim Nar ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cell Count ◽  
Degradation Products ◽  
Isotonic Saline ◽  
Control Group ◽  
Albino Rats ◽  
Peritoneal Fibrosis ◽  
Beneficial Effects ◽  
Group 2 ◽  
Wistar Albino Rats

Long-term use of the peritoneum as a dialysis membrane results in progressive irreversible dysfunction, described as peritoneal fibrosis. Oxidative stress during peritoneal dialysis has been established in many studies. Generation of reactive oxygen species (ROS) by conventional peritoneal dialysis solutions, regardless of whether produced by high glucose, angiotensin II, or glucose degradation products may be responsible for progressive membrane dysfunction. The well-known antioxidant molecule N-acetylcysteine (NAC) is capable of direct scavenging of ROS. The aim of the present study was to investigate the effect of NAC therapy on both progression and regression of encapsulating peritoneal sclerosis (EPS). We divided 49 nonuremic Wistar albino rats into four groups: Control group—2 mL isotonic saline intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for a total of 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal resting (weeks 4 – 6); NAC-R group—CG (weeks 1 – 3), plus 2 g/L NAC (weeks 4 – 6). At the end of the experiment, all rats underwent a 1-hour peritoneal equilibration test with 25 mL 3.86% PD solution. Dialysate-to-plasma ratio (D/P) urea, dialysate white blood cell count (per cubic milliliter), ultrafiltration (UF) volume, and morphology changes of parietal peritoneum were examined. The CG group progressed to encapsulating peritoneal sclerosis, characterized by loss of UF, increased peritoneal thickness, inflammation, and ultimately, development of fibrosis. Resting produced advantages only in dialysate cell count; with regard to vascularity and dialysate cell count, NAC was more effective than was peritoneal rest. Interestingly, we observed no beneficial effects of NAC on fibrosis. That finding may be a result of our experimental severe peritoneal injury model. However, decreased inflammation and vascularity with NAC therapy were promising results in regard to membrane protection.

scholarly journals Effect ofbalanceSolution on the Peritoneal Membrane in Automated Peritoneal Dialysis

2016 ◽  
Vol 36 (5) ◽  
pp. 569-572 ◽  
Author(s):  
Tatiana De los Ríos ◽  
Juan Pérez-Martínez ◽  
Jose Portoles ◽  
Monika Lichodziejewska-Niemierko ◽  
Maite Rivera ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Peritoneal Membrane ◽  
Open Label ◽  
Cell Functions ◽  
Neutral Ph ◽  
Appearance Rate ◽  
Glycation End Products ◽  
Membrane Cell

Interference of conventional peritoneal dialysis fluids (cPDFs) with peritoneal membrane cell functions may be attributed to the dialysis fluid's low pH, high glucose concentration, and/or the presence of glucose degradation products (GDPs), the last of which leads to higher levels of advanced glycation end-products (AGEs). It has been suggested that the peritoneal membrane might be better preserved by using biocompatible solutions, including cancer antigetn 125 (CA125). This prospective, open-label, multicentre, randomized, controlled, cross-over phase IV study compared the in vivo biocompatibility of a neutral-pH, low-GDP peritoneal dialysis (PD) solution ( balance) with a cPDF in automated PD (APD) patients. Our study revealed a significantly increased appearance rate and concentration of CA125 in the peritoneal effluent of APD patients treated with the neutral-pH, low-GDP solution balance versus a conventional PD solution.

scholarly journals Oxidative Stress in Patients Undergoing Peritoneal Dialysis: A Current Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-14 ◽  
Author(s):  
Vassilios Liakopoulos ◽  
Stefanos Roumeliotis ◽  
Xenia Gorny ◽  
Theodoros Eleftheriadis ◽  
Peter R. Mertens
Keyword(s):  
Oxidative Stress ◽  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Lactate Concentration ◽  
Residual Renal Function ◽  
Peritoneal Fibrosis ◽  
Glucose Content ◽  
Beneficial Effects ◽  
Vitamins E And C ◽  
Oxidative Products

Peritoneal dialysis (PD) patients manifest excessive oxidative stress (OS) compared to the general population and predialysis chronic kidney disease patients, mainly due to the composition of the PD solution (high-glucose content, low pH, elevated osmolality, increased lactate concentration and glucose degradation products). However, PD could be considered a more biocompatible form of dialysis compared to hemodialysis (HD), since several studies showed that the latter results in an excess accumulation of oxidative products and loss of antioxidants. OS in PD is tightly linked with chronic inflammation, atherogenesis, peritoneal fibrosis, and loss of residual renal function. Although exogenous supplementation of antioxidants, such as vitamins E and C, N-acetylcysteine, and carotenoids, in some cases showed potential beneficial effects in PD patients, relevant recommendations have not been yet adopted in everyday clinical practice.

scholarly journals Encapsulating Peritoneal Sclerosis (EPS): Analysis of Current Knowledge in the Literature and Observation of a Suspect Case

2020 ◽  
pp. 1-9
Author(s):  
Fabbri Nicolò ◽  
Fabbri Nicolò ◽  
S. Ferro
Keyword(s):  
Peritoneal Dialysis ◽  
Current Knowledge ◽  
Degradation Products ◽  
Pathological Process ◽  
Careful Monitoring ◽  
Advanced Glycation ◽  
Glycation End Products ◽  
Single Kidney ◽  
Dialysis Solutions ◽  
Suspect Case

Among the medical complications of long-lasting Peritoneal Dialysis (PD) a particular pathology has been observed, the so-called Encapsulating Peritoneal Sclerosis (EPS). The main properties of the pathological process of EPS is represented by proliferative fibrosis and sclerosis of the peritoneum, which lead to the formation of the typical "cocoon" and obstruction. Since glucose, Advanced Glycation End products (AGEs), and Glucose Degradation Products (GDPs), are responsible for peritoneum fibrosis and sclerosis, biocompatible peritoneal dialysis solutions are recommended, with reduced quantities of AGEs and GDPs. Furthermore, careful monitoring of the patients is very important, especially after 5-8 years of PD. We performed an overview of the current literature available and discuss a “suspect” case of a 59-year-old male patient who underwent a single kidney transplant after a period of 8 year of peritoneal dialysis with numerous sub occlusive episodes, some of them required hospitalizations in a period between 2011 and 2019. Patient underwent to several radiologic exams for a suspect of a cocoon syndrome.

The Influence of Bicarbonate/Lactate-Buffered PD Fluids on Nε-(Carboxyethyl)Lysine and Nε-(Carboxymethyl)Lysine in Peritoneal Effluent

2011 ◽  
Vol 31 (2) ◽  
pp. 189-193 ◽  
Author(s):  
Trijntje T. Cnossen ◽  
Ulrich Gladziwa ◽  
Jos J. Van De Kerkhof ◽  
Casper G. Schalkwijk ◽  
Jean Scheijen ◽  
...  
Keyword(s):  
Degradation Products ◽  
Residual Renal Function ◽  
Glycation End Products ◽  
Before And After ◽  
Group A ◽  
Carboxymethyl Lysine ◽  
Low Levels ◽  
Group B ◽  
Dialysis Solutions ◽  
Control Study

ObjectiveAccumulation of advanced glycation end products (AGEs) may be involved in the pathogenesis of peritoneal membrane dysfunction. As glycoxidation may play an important role in AGE formation, peritoneal dialysis fluids with low levels of glucose degradation products (GDPs) might result in a reduction in AGE concentration in the peritoneal effluent. The aim of this study was to compare the effects of conventional glucose-containing dialysis solutions and low GDP level fluids on the concentration of the AGEs Nε-(carboxymethyl)lysine (CML) and Nε-(carboxyethyl)lysine (CEL) in peritoneal effluent.DesignProspective randomized control study.Methods23 patients were treated with either conventional glucose-containing fluid ( n = 11, group A) or low level GDP fluid ( n = 12, group B) during a period of 12 weeks. Before and after this period, CML and CEL were measured in peritoneal effluent.ResultsIn groups A and B there were changes in CML concentrations [respectively 13.7 ± 17.0 and -16.0 ± 46.0 nmol/L (NS)] and CEL concentrations (respectively 20.3 ± 26.6 and -8.8 ± 18.9 nmol/L, p = 0.015). Residual renal function (RRF) in groups A and B was, respectively, 6.8 and 6.1 mL/min (NS). CML, but not CEL, in the peritoneal effluent was inversely related to RRF ( r = -0.67, p < 0.05).ConclusionCEL, but not CML, in the peritoneal effluent appears to be influenced by the prescription of low GDP level fluid, probably due to the highly reduced concentration of methylglyoxal, which is needed for formation of CEL. CML is primarily influenced by RRF.

Renal clearance of glycation adducts: anti-glycation defence in uraemia and dialysis

2003 ◽  
Vol 31 (6) ◽  
pp. 1386-1389 ◽  
Author(s):  
A. Dawnay
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Clearance ◽  
Plasma Concentrations ◽  
Carbonyl Stress ◽  
Advanced Glycation ◽  
Elevated Protein ◽  
Glycation End Products ◽  
End Products ◽  
Carboxymethyl Lysine ◽  
Dialysis Fluids

Increased plasma concentrations of free AGEs (advanced glycation end products) in uraemia are due to impaired renal clearance exacerbated by dietary load and breakdown of the elevated protein-bound AGEs. Increased protein-bound AGEs most probably reflect increased synthesis due to the increased oxidative and carbonyl stress of uraemia, which is exacerbated by the dialysis procedure. Use of biocompatible peritoneal dialysis fluids and haemodialysis membranes will be beneficial, but strategies to further reduce AGE formation are required. These should focus on the hydroimidazalone AGEs, which are quantitatively the most important, and not only on the conventionally monitored AGEs N∊-carboxymethyl-lysine and pentosidine.

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