Comparison of in vitro AGE formation between standard PD fluid and a novel bicarbonate/lactate formulation

Peritoneal advanced glycation end-product (AGE) formation may be accelerated by glucose degradation products produced as a consequence of heat sterilization of peritoneal dialysis (PD) fluid. The formation of these degradation products is reduced if the glucose is separated from the buffers during heat sterilization. This pilot study compared in vitro AGE formation in PD fluid (1.36% and 3.86% glucose) heat sterilized in a two-compartment bag (bicarbonate/lactate buffer) with that in a standard, single-compartment bag (lactate buffer, Dianeal). Peritoneal dialysis fluids were incubated with human serum albumin (HSA, 1 g/L), as a model protein, at 37 degrees C for 0, 5, and 20 days. Formation of AGEs was assessed by measuring fluorescence at each time point. Advanced glycation end-product formation was greater in lactate PD fluid compared with bicarbonate/lactate PD fluid of equivalent glucose strength. Advanced glycation end-product formation in the lactate PD fluid containing 1.36% glucose was comparable to that in the bicarbonate/lactate PD fluid containing 3.86% glucose. The rate of increase in fluorescence per day was greater in the first 5 days of incubation than in the subsequent 15 days. These results are compatible with the presence of greater amounts of glucose-degradation products in the standard single-compartment bag resulting in enhanced AGE formation.