Glucose degradation products (GDP's) and peritoneal changes in patients on chronic peritoneal dialysis: Will new dialysis solutions prevent these changes?

Murali Krishnan, Paul Tam, George Wu, Andrzej Breborowicz, Dimitrios G. Oreopoulos

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

As peritonitis rates are declining, the rate of technique failure due to ultrafiltration failure and inadequate solute removal is becoming more important. The failure of the peritoneal membrane to provide adequate dialysis increases with longer duration on PD and correlates with the structural changes in the peritoneal membrane. The exact mechanism responsible for these structural changes is unclear. Conventional PD fluids with glucose as the osmotic agent and more importantly the glucose degradation products (GDP) generated during the heat sterilization of these solutions seems to be responsible for inducing many of these changes in the peritoneum. GDP's in addition to causing structural and functional alterations of the peritoneal cells is also a leading cause of advanced glycation end-products (AGE) production. There is evidence to suggest that the GDP's and AGE's are not limited to the peritoneal cavity and the membrane. They have been shown to get deposited in the vascular walls. In addition they also interact with receptors on endothelial cells and smooth muscle. Thus they could contribute to the vascular dysfunction similar to that seen in diabetes. Formation of GDP's can be reduced and even be avoided with the use of newer "biocompatible" solutions by sterilizing the glucose and the buffer in separate chambers. These newer solutions have been shown to have several local and systemic advantages over the conventional PD solutions. It remains to be seen whether their chronic use from the start of peritoneal dialysis will prevent the development of peritoneal damage thus allowing these patients to remain on this modality for longer periods.

Original languageEnglish (US)
Pages (from-to)409-418
Number of pages10
JournalInternational Urology and Nephrology
Volume37
Issue number2
DOIs
Publication statusPublished - Jun 1 2005

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Keywords

  • Biocompatibility
  • Glucose degradation products
  • Peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology
  • Urology

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