Influence of hemodialysis membrane permeability on serum levels of advanced glycation end products (AGEs) and homocysteine metabolites.

Abstract

BACKGROUND:

[corrected] Advanced glycation end products (AGEs), total homocysteine (tHcy) and the homocysteine metabolites cystathionine (Cysta) and dimethylglycine (DMG) are increased in serum of patients with end-stage renal disease. The aim of this prospective randomized study was to compare the efficacy of polysulfone high-flux vs. polysulfone low-flux hemodialysis (HD) treatment regarding removal of AGEs, tHcy, Cysta and DMG.

PATIENTS AND METHODS:

Twenty-nine patients on chronic HD treatment were randomly assigned to 2 groups in a 3-period 2-treatment design with low flux (A)--high flux (B)--low flux (A) for group I and B-A-B for group II, 6 weeks each period. The following parameters were measured in pre- and postdialytic serum samples at baseline and the end of each period: total serum fluorescence, Nepsilon-carboxymethyllysine (CML), free and protein-bound pentosidine, tHcy, Cysta and DMG.

RESULTS:

There was increased removal of free pentosidine during high-flux HD treatment compared to low-flux HD treatment, attaining significance between the second and third treatment periods (group 1: 86.0 +/- 4.7% vs. 79.2 +/- 8.8%, p = 0.007; group II: 84.0 +/- 6.3% vs. 79.8 +/- 9.8%, p = 0.049 for high vs. low flux). The intradialytic reduction rates for total serum fluorescence, tHcy, Cysta, DMG did not differ between high- and low-flux HD treatment. Protein-bound pentosidine and CML did not decrease during the dialysis sessions, neither with high-flux nor with low-flux HD membrane. Despite a strong decrease during single HD session, the predialytic levels of free pentosidine, tHcy, Cysta and DMG remained unchanged during the study period both for high- and low-flux HD treatment.

CONCLUSION:

The more pronounced effect of high-flux dialysis on the removal rate of free pentosidine, found in this randomized crossover study, could not translate into a significant difference in predialysis levels after a 6-week treatment period. We could not find any differences between polysulfone high- and low-flux membranes for lowering predialytic serum concentrations of the measured AGEs, which are mainly bound on albumin.

• Authors: A Klemm, C Franke, M Busch, A Müller, S Franke, D Lang, J Passlick-Deetjen, G Stein
• Journal: Clinical nephrology (Clin Nephrol) Vol. 61 Issue 3 Pg. 191-7 (Mar 2004) ISSN: 0301-0430 [Print] Germany
• PMID: 15077870 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Glycation End Products, Advanced
• Membranes, Artificial
• Polymers
• Sulfones
• Homocysteine
• polysulfone P 1700
• Cystathionine
• dimethylglycine
• Arginine
• pentosidine
• Lysine
• Sarcosine

Topics

• Arginine (analogs & derivatives, blood)
• Cross-Over Studies
• Cystathionine (blood)
• Enzyme-Linked Immunosorbent Assay
• Female
• Fluorescence
• Glycation End Products, Advanced (blood)
• Homocysteine (metabolism)
• Humans
• Kidneys, Artificial
• Lysine (analogs & derivatives, blood)
• Male
• Membranes, Artificial
• Middle Aged
• Polymers
• Prospective Studies
• Renal Dialysis (instrumentation, methods)
• Sarcosine (analogs & derivatives, blood)
• Sulfones