Mueller-Krebs S, Kihm LP, Zeier B, et al.
Renal Toxicity of Glucose Degradation Products in Peritoneal Dialysis.
ASN Annual Meeting -- San Francisco
J Am Soc Nephrol
(Nov) 18:690A 2007

Purpose: In peritoneal dialysis residual renal function contributes to
improved patient survival and quality of life. Glucose degradation products
(GDP) impair not only the peritoneal membrane, they appear in the systemic
circulation with potential organ toxicity. In subtotally nephrectomized (SNX)
rats, we examined whether GDP affects the structure and function of the
remnant kidney.
Methods: Sprague-Dawley (SD) rats were randomly
assigned to a two-stage SNX or sham operation and were left untreated for 3
weeks. SNX+GDP group received chemically defined GDP by an osmotic mini-pump
intravenously for 4 weeks; the SNX and the sham operated groups remained
without GDP. The complete follow-up for all groups was 7 weeks post-
operatively.
Results: The SNX+GDP rats developed significantly more
albuminuria (12.3
4.96 mg/24 h vs. SNX 5.68
2.77 mg/24 h; p
0.05) and showed a significantly higher index of glomerulosclerosis (2.18
0.33 vs. 1.82
0.23; p
0.01) and tubulointerstitial damage (2.17
0.29 vs. 1.78
0.22; p
0.01). In SNX+GDP expression of
carboxymethyllysin and methylglyoxal was significantly higher in the
tubulointerstitium and the glomeruli compared to the SNX rats. Caspase 3 and
TUNEL assay were more pronounced in the tubulointerstitial space and the
glomeruli of the SNX+GDP. In SNX+GDP animals podocyte damage was
significantly higher compared to SNX and sham operated animals. Blood
pressure was similar in SNX+GDP (134
8.63)
versus SNX (135
9.25;
p=ns).
Conclusion: In subtotally nephrectomized rats, administration
of GDP increased albuminuria, indices of glomerular and tubulointerstitial
damage significantly, specifically with a rarefication and perturbation of
podocytes. It is likely that GDP-free PD solutions maintain and stabilize
residual renal function in PD.
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