Advanced Glycation End Product Free Adducts Are Cleared by Dialysis

• Published in: Annals of the New York Academy of Sciences 2005-06, Vol.1043 (1), p.734-739
• Main Authors: AGALOU, S, AHMED, N, THORNALLEY, P J, DAWNAY, A
• Format: Article
• Language: English
• Subjects: 3-deoxyglucosone; Adducts; Adult; Age; carboxyethyl lysine; carboxymethyl lysine; clearance; Control equipment; Dialysis; Effluents; Excretion; Female; glucose degradation products; glycation; Glycation End Products, Advanced - blood; Glycation End Products, Advanced - isolation & purification; glyoxal; Humans; hydroimidazolone; Magnesium; Male; Metabolic Clearance Rate; methylglyoxal; Middle Aged; Patients; pentosidine; Peritoneal Dialysis, Continuous Ambulatory; Reference Values; Renal Dialysis
• ISSN: 0077-8923; 1749-6632
• DOI: 10.1196/annals.1333.085

: Plasma advanced glycation end product (AGE) free adducts are increased up to 50‐fold among patients on dialysis. We examined the ability of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) to clear these compounds. The AGE free adducts Nε‐carboxymethyl‐lysine (CML) and Nε‐(1‐carboxyethyl)lysine (CEL) and the hydroimidazolones derived from glyoxal (G‐H1), methylglyoxal (MG‐H1), and 3‐deoxyglucosone (3DG‐H) were determined by LC‐MS/MS and pentosidine by HPLC with fluorimetric detection in ultrafiltrates of plasma, urine, or PD effluent as appropriate from patients on HD (n= 8) or PD (n= 8), and from healthy controls (n= 8). Among patients on HD, all free AGEs predialysis were significantly higher than in controls and were decreased with dialysis. The removal of MG‐H1 and 3DG‐H was comparable to that of urea, whereas that of CML and pentosidine was some 20% higher; in contrast, the removal of CEL and G‐H1 was 25% lower. Among patients on CAPD, free AGEs in PD effluent increased with increasing dwell time. The combined renal and peritoneal 24‐h excretion rates of CML (4.7 μmol), CEL (6.5 μmol), 3DG‐H (16.6 μmol), and pentosidine (0.08 μmol) were twofold higher than the amount excreted in healthy controls, whereas MG‐H1 was ninefold higher (59 μmol); the combined clearances of all free AGEs except pentosidine were lower than in healthy controls. Impaired renal clearance contributes to increased plasma free AGEs in uremia, but the increased excretion rate among patients on PD demonstrates that there was also an increased synthesis of free AGEs. Both HD and PD are able to remove free AGEs.