Influence of dialysis modalities on serum AGE levels in end-stage renal disease patients

Background, The accumulation of advanced glycation end-products (AGEs) in e nd-stage renal disease (ESRD) influenced by dialysis modalities is of curre nt interest. Highly permeable membranes in haemodialysis or haemofiltration should be able to eliminate circulating ACEs as well as their AGE precurso rs more efficiently. Methods. In our study, 10 non-diabetic and 10 diabetic ESRD patients were o n haemodialysis with low-flux membranes (LF) followed by a cross-over haemo dialysis with high-flux or super-flux polysulfone membranes (HF, SF) for 6 months each. We measured the protein-bound pentosidine and free pentosidine serum levels by high-performance liquid chromatography (HPLC) as well as t he serum AGE peptide, AGE-beta (2)-microglobulin and beta (2)-microglobulin concentrations, using ELISA assays. Results. Ail parameters investigated were significantly higher in dialysis patients than in healthy subjects. The reduction rates during a single dial ysis session were found to be higher using the SF than those obtained with the HF (free pentosidine 82.4 +/- 7.3 cs 76.6 +/- 87%; AGE peptides 79.7 +/ - 7.7 vs 62.3 +/- 14.7%;, AGE-beta (2)-microglobulin 64.0 +/- 16.5 vs 45.4 +/- 17.7%; beta (2)-microglobulin 70.5 +/- 5.6 vs 58.2 +/- 6.0%). The prote in-hound pentosidine levels remained constant over the respective dialysis sessions, In the 6-month treatment period with the SF, decreased pre-dialys is serum levels of protein-bound pentosidine, free pentosidine and AGE pept ides were observed in nondiabetics and diabetics as compared with values ob tained with the LF. The respective pre-dialysis AGE-beta (2)-microglobulin concentrations decreased insignificantly, whereas those of beta (2)-microgl obulin were significantly lower. Using the HF dialyser, only moderate chang es of the parameters measured were noted. Conclusion. Treatment with the biocompatible polysulfone SF dialyser seems to be better suited to lower serum AGE levels and to eliminate their precur sors.