Skin- and Plasmaautofluorescence in hemodialysis with glucose-free or glucose-containing dialysate

Bernd Ramsauer,Bernd Stegmayr,Reindert Graaff,Stefan Arsov,Gerwin Erik Engels,Aleksandar Sikole

doi:10.1186/s12882-016-0418-0

Abstract

BackgroundHaemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD). Skin autofluorescence (SAF) is a strong marker for CVD. SAF indirectly measures tissue advanced glycation end products (AGE) being cumulative metabolites of oxidative stress and cytokine-driven inflammatory reactions. The dialysates often contain glucose.MethodsAutofluorescence of skin and plasma (PAF) were measured in patients on HD during standard treatment (ST) with a glucose-containing dialysate (n = 24). After that the patients were switched to a glucose-free dialysate (GFD) for a 2-week period. New measurements were performed on PAF and SAF after 1 week (M1) and 2 weeks (M2) using GFD. Nonparametric paired statistical analyses were performed between each two periods.ResultsSAF after HD increased non-significantly by 1.2% while when a GFD was used during HD at M1, a decrease of SAF by 5.2% (p = 0.002) was found. One week later (M2) the reduction of 1.6% after the HD was not significant (p = 0.33). PAF was significantly reduced during all HD sessions. Free and protein-bound PAF decreased similarly whether glucose containing or GFD was used. The HD resulted in a reduction of the total PAF of approximately 15%, the free compound of 20% and the protein bound of 10%. The protein bound part of PAF corresponded to approximately 56% of the total reduction. The protein bound concentrations after each HD showed the lowest value after 2 weeks using glucose-free dialysate (p < 0.05). The change in SAF could not be related to a change in PAF.ConclusionsWhen changing to a GFD, SAF was reduced by HD indicating that such measure may hamper the accumulation and progression of deposits of AGEs to protein in tissue, and thereby also the development of CVD. Glucose-free dialysate needs further attention. Protein binding seems firm but not irreversible.Trial registrationISRCTN registry: ISRCTN13837553. Registered 16/11/2016 (retrospectively registered).

Highlights

Haemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD)
We were able to show that a single session of HD significantly reduced plasma autofluorescence (PAF) but not Skin autofluorescence (SAF) [22]
Comparing the reduction (Δ PAF after - Δ PAF before dialysis) of the total, free, protein bound PAF there was no difference in reduction by dialysis at the first measurement (ST) versus Measurement after 1 week with glucose-containing dialysate (M1) or 1 week later (M2)

Summary

Introduction

Haemodialysis (HD) patients suffer from an increased risk of cardiovascular disease (CVD). Skin autofluorescence (SAF) is a strong marker for CVD. Cardiovascular morbidity and mortality are increased in patients with decreasing kidney function [1, 2] and endstage renal disease (ESRD). AGEs accumulate more in HD because of increased production by oxidative stress caused by the dialysis per se [9] and lowered elimination by the impaired kidneys. Skin autofluorescence (SAF) is related to the accumulation of AGE and is one of the strongest prognostic markers of mortality in these patients [8]. SAF is an indirect marker for glucose degradation products [8], present in the skin and in other tissues [11]

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