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      N-Acetylglucosamine – An Osmotic Solute for Peritoneal Dialysis without Inducing Hyperinsulinemia

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          Methods: N-Acetylglucosamine (NAG) was compared to glucose as an osmotic solute during peritoneal dialysis in rats. The effect of the tested solutes on blood glucose and insulin levels during dialysis was evaluated. Results: During 6-hour exchange with NAG (220 mmol/l) solution, the dialysate volume was higher than in rats dialyzed with fluid containing glucose (220 mmol/l; GLU: 34.5 ± 1.7 vs. 32.8 ± 1.1 ml, respectively; p < 0.05). The peritoneal permeability to protein (D/S × 1,000) was lower in the NAG group (9.7 ± 2.5 vs. 16.3 ± 5.6 in GLU; p < 0.02). Dialysis with GLU-based solution resulted in hyperglycemia up to 180 ± 39 mg/dl; in the NAG group the increase in the blood glucose level was moderate (up to 91 ± 9 mg/dl; p < 0.001). Dialysis with GLU fluid caused an increase in blood insulin level by 53.2 ± 62.4 pmol/l, whereas the insulin blood concentration in NAG-treated animals was increased by 5.0 ± 5.4 pmol/l (p < 0.001). Conclusions: NAG is more effective than GLU osmotic solute during peritoneal dialysis and it reduces peritoneal permeability to protein. Dialysis with NAG results in lower hyperglycemia and hyperinsulinemia, both effects are favorable in diabetic peritoneal dialysis patients.

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          Allergic reactions to the polymeric glucose-based peritoneal dialysis fluid icodextrin in patients with renal failure.

          A new glucoee polymer, icodextrin, related to maltose, is in increasing use as a peritoneal dialysis fluid. We report on adverse events seen in our unit during a 12-month period after the introduction of this reagent.
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            Dialysis solution containing hyaluronan: effect on peritoneal permeability and inflammation in rats.

            Hyaluronan (HA), a high molecular weight mucopolysaccharide found in interstitial tissues and fluid, is lost from the peritoneal cavity during peritoneal dialysis. In order to determine the role of HA in peritoneal function, we investigated the effects of exogenous HA on peritoneal permeability, markers of intraperitoneal inflammation, and peritoneal morphology in rats exposed to peritoneal dialysis solution for four weeks. Wistar rats were infused intraperitoneally, twice daily, with conventional, hypertonic dialysis solution (Dianeal 3.86%; control) or Dianeal solution containing 10 mg/dL of high molecular weight HA. Peritoneal permeabilities and clearances of solutes and protein were determined using a modified peritoneal permeability test (peritoneal equilibration test) at the beginning and the end of the treatment. Peritoneal volume and ultrafiltration were determined using a macromolecular marker and by gravimetric methods. Peritoneal inflammation was determined by cell counts and differential and by the measurement of cytokine concentrations in the dialysate effluent. Peritoneal thickness and HA content were determined in liver and mesentery biopsies taken at the end of the experiment. After four weeks of exposure to the dialysis solution, transperitoneal protein equilibration was significantly lower in HA-treated rats compared with rats treated with Dianeal alone (46% lower for albumin, P < 0.003; 33% lower for total protein, P < 0.001). The total drained volume after a four hour dwell was 29% higher in the HA group compared with the control (P < 0.001), yielding a positive net ultrafiltration in the HA group versus a negative net ultrafiltration in controls. Peritoneal clearances of urea and creatinine tended to be elevated in HA-treated rats, while clearances of total protein and albumin tended to be lower. Dialysate effluent from rats exposed to HA contained a lower percentage of neutrophils (8.8 +/- 22.8 +/- 9.5%, P < 0.01) and lower levels of the cytokines, tumor necrosis factor-alpha (11.2 +/- 14.7 vs. 42.3 +/- 35.3 pg/mL, P < 0.05) and monocyte chemoattractant protein-1 MCP-1 (72.0 +/- 86.5 vs. 402.4 +/- 258.3 pg/mL, P < 0.02), compared with rats treated with Dianeal alone. The thickness of the peritoneal interstitium showed a similar increase in both groups, but mesenteric tissue from the HA group contained more HA (48%, P < 0.01) than tissue from control animals. The addition of HA to peritoneal dialysis solution decreases protein permeability, increases ultrafiltration, and decreases cytokine levels and the proportion of peritoneal neutrophils in dialysate from rats exposed to hypertonic dialysis solution. These results suggest that exogenous HA may help to protect the peritoneal membrane during exposure to dialysis solutions. These benefits, if sustained in the clinical setting, could lead to improvements in the therapy of peritoneal dialysis.
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               E GAULDEN,  W KEATING (1964)

                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                July 2004
                30 March 2004
                : 22
                : 2
                : 183-187
                aDepartment of Pathophysiology, Poznan Medical School, Poznan, Poland; bSRI Partnership, Toronto,Ont., Canada
                76851 Blood Purif 2004;22:183–187
                © 2004 S. Karger AG, Basel

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                Page count
                Figures: 2, Tables: 2, References: 25, Pages: 5
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/76851
                Original Paper

                Cardiovascular Medicine, Nephrology

                Insulin, N-Acetylglucosamine, Glucose, Peritoneal dialysis


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