Can We Prevent the Degradation of Glucose in Peritoneal Dialysis Solutions?

Abstract

Correspondence to: I. Ledebo, Gambro Research, Box 10101, Lund 220 10 Sweden. As the main source of energy in the human body, glucose has a central function. Carbohydrates in the diet are often metabolized to glucose, and when carbohydrates are lacking, glucose is synthesized de novo from amino acids. Thus, glucose in itself can hardly be considered toxic. Still, pharmaceutically prepared glucose solutions have several biological side effects, such as growth inhibition on cultured cells and microorganisms. Many scientific disciplines have shown the effects, but so far, the causes are little investigated and understood. Under the influence of certain promoting factors, the glucose molecule degrades. The many new molecules formed are commonly called glucose degradation products (GDPs). Among the GDPs are some reactive aldehydes—for example, acetaldehyde, formaldehyde, methylglyoxal and 3-deoxyglucosone— which, apart from their inherent toxic effect on cells, have been shown to participate in the glycosylation of amino groups, thus forming Amadori products and irreversibly glycosylated proteins, called advanced glycosylated end-products (AGEs) (1,2). Because glucose solutions are needed in medical therapy, finding methods for preventing the formation of GDPs is important. In chronic therapies such as peritoneal dialysis (PD), a patient may be exposed to the equivalent of about 100 kg of glucose per year. When PD solution is sterilized in the standard manner, large amounts of GDPs are formed in the solution. Our awareness about the clinical impact of chronic exposure to these toxic and reactive substances is still limited.