Amadori albumin and advanced glycation end-product formation in peritonealdialysis using icodextrin

Objective:To study the influence of peritoneal dialysis (PD) solutions on t he formation of early glycated products and advanced glycation end-products (AGEs). Design and Patients: The formation of both Amadori albumin and AGEs in gluc ose- 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 Po fluids showed a time- and g lucose concentration-dependent formation of Amadori albumin and AGEs. Amino guanidine completely inhibited AGE but not Amadori albumin formation. Album in incubated in icodextrin resulted in the lowest levels of Amadori albumin and AGE. Amadori albumin levels in effluents of 24 CCPD patients (12 gluco se and 12 icodextrin for their daytime dwells) were similar. Dialysate samp les collected during a mass transfer area coefficient test in 16 CCPD patie nts (8 glucose, 8 icodextrin) showed an increase in Amadori albumin formati on from baseline (p < 0.0001), without a difference between the groups. In the total group, there was a positive relationship between duration on PD a nd dialysate Amadori albumin concentration at 240 minutes (p = 0.03). The A madori 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, white 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 pat ients using icodextrin during daytime dwells do not have lower effluent lev els of Amadori albumin and AGEs, probably due to the exposure to glucose du ring their nighttime exchanges. Kinetic studies suggest washout of locally produced Amadori albumin.