Impact of glucose levels on advanced glycation end products in hemodialysis

Abstract

The current obesity epidemic throughout the western world has resulted in a considerable increase in the condition Type II diabetes mellitus. Recently, the World Health Organization has predicted that the global prevalence of Type II will increase from 175 million patients in 2003 to over 350 million by 2030. One of the major consequences of this disorder is renal failure, which presents itself as chronic kidney disease, and can progress to end-stage renal disease. Once diagnosed, patients are generally treated using dialysis due to a shortage of kidney donors. The fundamental process of dialysis still requires improvement because the survival rate of these patients is relatively poor. This has resulted in considerable research into improvements in hemodialysis membranes, and the challenge to find more suitable marker(s) in assessing the efficacy of the dialysis process. A class of compounds highlighted as a possible accumulative toxin is advanced glycation end products or AGEs. This is an article regarding the impact of hemodialysis and hemodiafiltration on glucose and AGE levels within the body and the consequences of a chronic hyperglycemic condition. It also highlights the negative aspects of using dextrose in conventional dialysis solutions (an area that has already been identified by peritoneal dialysis clinicians as problematic). The review concludes by suggesting several possible topics of future research.

Tissue-Advanced Glycation End Product Concentration in Dialysis Patients

“…Glycemic exposure and GDPs have been implicated in the development of AGEs in those receiving PD, but importantly, HD dialysate contains glucose, reaching concentrations of 200 mg/dl (28). Potentially, therefore, in patients receiving HD, there is significant thrice-weekly additional glycemic exposure in addition to the AGEs generated by metabolic stress during the course of their progressive kidney disease.…”

Handling Continuous Renal Replacement Therapy-Related Adverse Effects in Intensive Care Unit Patients: The Dialytrauma Concept

“…A net, though somewhat lower in the dextrose-free cohort, positive uptake was detected in both groups [24]. Still, several problems regarding the addition of glucose to dialysis solutions have been recognized [25] and the dynamics of the dialyzer mass transfer for glucose have not been definitely clarified [26]. Supplementing glucose to the replacement fluid may produce a net glucose uptake of up to 300 g/day in patients under arteriovenous hemofiltration [27].…”

Tissue Advanced Glycation End Product Deposition after Kidney Transplantation

“…In ESRD, AGE accumulation is elevated in both diabetic and non-diabetic patients, suggesting that hyperglycaemia alone does not account for the increase [12,13]. AGEs as measured by SAF have also been shown to be higher in patients on haemodialysis and peritoneal dialysis (PD) compared to non-uraemic control subjects [14].…”