Effect of the peritoneal dialysis prescription on pentosidine in children
Enhanced formation of advanced glycation end products (AGEs) by peritoneal dialysate containing high dextrose concentrations has been implicated as a source of peritoneal membrane toxicity and loss of viability in patients treated with peritoneal dialysis (PD). The goal of this project was to elucidate the relationship between the structurally defined AGE pentosidine accumulation on peritoneal and plasma proteins and peritoneal membrane function, and to identify clinical factors leading to alterations in these parameters. The study comprised 27 pediatric patients (14 continuous ambulatory PD, 13 chronic cycling PD) on PD for a mean duration of 37.0±22.8 months (range 1–120 months) and with a mean age of 13.3±4.4 years (range 2.4–20 years). The pentosidine contents of plasma and peritoneal proteins were significantly lower in patients with residual renal function than in patients who were anuric (plasma pentosidine 11.2±8.8 vs. 24.1±16.6, P=0.02, respectively, peritoneal pentosidine 14.9±11.9 vs. 31.1±3.7, P=0.01, respectively). There was no effect of treatment modality on plasma pentosidine (18.1±11.2, 18.8±19.3, CAPD vs. CCPD, P>0.05) or peritoneal pentosidine content (24.1±14.1, 24.9±19.6, CAPD vs. CCPD, P>0.05). There was no evidence that increased levels of pentosidine on peritoneal proteins reflect or affect peritoneal membrane function in these patients. Furthermore, there was no effect of peritonitis on the pentosidine content of peritoneal proteins or peritoneal function as measured by peritoneal equilibration test. In conclusion, PD represents a well-tolerated therapy in children with no evidence that current practice causes changes in peritoneal membrane function, or in the peritoneal clearance of plasma or peritoneal proteins rich in pentosidine.