Influence of hemodialysis membrane type on pentosidine plasma level, a marker of "carbonyl stress"

Background. The accumulation of advanced glycation end products (AGEs) in u remia has been ascribed to the retention of carbonyl precursors of AGEs. Pe ntosidine plasma level has been identified as a surrogate marker of carbony l precursors ("carbonyl stress"). The influence of hemodialysis (HD) membra ne type and residual diuresis on carbonyl stress has not been studied. Methods. We measured protein-linked and free plasma pentosidine (a surrogat e marker of carbonyl stress) by high-performance liquid chromatography in p atients on HD with low-flux cellulose (N = 29), high-flux polysulfone (PS; N = 57), polymethylmethacrylate (PMMA) (N = 25), and AN69 (N = 15). Results. Both protein-linked and free pentosidine were similar on low-flux cellulose, high-flux PMMA, and AN69, but were lower (P < 0.01) on high-flux PS. Pentosidine levels were virtually identical on Fresenius and Asahi PS in Japanese and Belgian patients. By multivariate analysis, only the type o f HD membrane and residual diuresis proved to be independent determinants ( P < 0.001) of pentosidine levels. During a single HD session, the clearance of free pentosidine was similar with all membranes. In three patients who were switched from AN69 to PS, the protein-linked pentosidine level dropped to the control level after resumption of the AN69 membrane. Conclusions. Both HD membrane type and residual diuresis are independent de terminants of pentosidine plasma level, which is a marker of carbonyl stres s.