Peritoneal accumulation of advanced glycosylation end-products in diabeticrats on dialysis with icodextrin

Objective: To evaluate and compare the effects of glucose-based solutions t o those of icodextrin with respect to peritoneal transport characteristics and formation of advanced glycosylation end-products (AGEs) in the peritone al membrane in the diabetic rat model of peritoneal dialysis (PD). Study Design: Thirty-three male Sprague-Dawley rats weighing between 275 - 300 g were divided into 5 groups: group C (n = 6), control rats with cathet er but not dialyzed; group D (n = 5), diabetic rats with catheter but not d ialyzed; group G (n = 7), diabetic rats dialyzed with standard 2.5% glucose solution for daytime exchanges and 4.25% glucose solution for the overnigh t exchange; group H (n = 8), diabetic rats dialyzed with standard 2.5% gluc ose solution for daytime exchanges and 7.5% icodextrin solution for overnig ht exchanges; group I (n = 7), diabetic rats dialyzed with 7.5% icodextrin solution for all exchanges. Dialysis exchanges were performed three times d aily with an instillation volume of 25 mt per exchange for a period of 12 w eeks. Tissue sections were stained using a monoclonal anti-AGE antibody. On e-hour peritoneal equilibration tests (PET) were performed every 4 weeks fo r comparison of transport characteristics. Results: The level of immunostaining was lowest in group C and highest in g roup G, Significant differences were seen between group C and groups G, H, and I (p < 0.001, p = 0.001, and p < 0.05 respectively). Significant differ ences were also found between group G and groups D and I (p < 0.05 and p < 0.05 respectively). Over time, glucose concentration at the end of an excha nge versus concentration at instillation (D/D-0 glucose) decreased and dial ysate-to-plasma ratio (D/P) of urea increased. Significant differences were found between groups C and H for D/D-0 glucose (0.40 +/- 0.01 vs 0.35 +/- 0.01, p < 0.05); and between groups C and H for D/P urea (0.87 +/- 0.03 vs 0.97 +/- 0.02, p < 0.05). Conclusions: These results suggest that AGE formation is lower with the use of peritoneal dialysis solution containing icodextrin than with glucose-ba sed solutions. We conclude that the use of icodextrin may be helpful in slo wing the deterioration of the peritoneal membrane, prolonging its use for d ialysis.