N-acetylglucosamine - An osmotic solute for peritoneal dialysis without inducing hyperinsulinemia

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 x 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.