Ultrapure dialysate decreases plasma pentosidine, a marker of "carbonyl stress"
(2004) American Journal of Kidney Diseases — Vol. 43, n° 6, p. 1024-1029 (2004)
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- Background: Advanced glycation end products (AGEs) and their reactive carbonyl precursors accumulate in renal failure ("carbonyl stress"). Carbonyl stress derives from a broad derangement in the nonenzymatic biochemistry of both carbohydrates and lipids. We tested the influence of dialysate quality on plasma level of pentosidine, an AGE moiety taken as a surrogate marker of carbonyl stress, in hemodialysis patients. Methods: Plasma pentosidine is measured by means of high-performance liquid chromatography in patients hemodialyzed successively with a conventional and an ultrapure endotoxin-free dialysate. Results: Dialysate endotoxin level decreased from 0.040+/-0.017 EU/mL before the switch to the new water supply system to less than the detection limit (<0.001 EU/mL) after the switch. Plasma pentosidine levels decreased from 1.55&PLUSMN;0.61 nmol/mL before the switch to 1.38&PLUSMN;0.52 nmol/mL (P<0.0001) and 1.31+/-0.50 nmol/mL (P<0.0001) 3 and 6 months after the switch to an ultrapure dialysate, respectively. Decreases in plasma pentosidine levels were similar regardless of dialyzer membrane type; ie, high-flux polysulfone, high-flux polymethylmethacrylate, and low-flux cellulose acetate membranes. Unexpectedly, plasma triglyceride levels decreased from 150&PLUSMN;116 mg/dL (1.69&PLUSMN;1.31 mmol/L) before the switch to 124&PLUSMN;79 mg/dL (1.40&PLUSMN;0.89 mmol/L; P<0.01) and 119+/-75 mg/dL (1.34+/-0.85 mmol/L; P<0.01) 3 and 6 months after the switch despite unchanged total cholesterol levels, respectively. Changes in pentosidine levels were unrelated to those in triglycerides, and both were unrelated to C-reactive protein levels, which remained stable throughout the study. Conclusion: Ultrapure dialysate reduces plasma pentosidine levels and improves plasma triglyceride levels in hemodialysis patients through still undefined mechanisms.
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Izuhara, Y., Miyata, T., Saito, K., Ishikawa, N., Kakuta, T., Nangaku, M., Yoshida, H., Saito, A., Kurokawa, K., & Van Ypersele de Strihou, C. (2004). Ultrapure dialysate decreases plasma pentosidine, a marker of “carbonyl stress”. American Journal of Kidney Diseases, 43(6), 1024-1029. https://doi.org/10.1053/j.ajkd.2004.02.015 (Original work published 2004)