Nonenzymatically glucosylated serum proteins in patients with end-stage renal disease

We report here abnormally elevated levels of nonenzymatically glucosylated whole-serum proteins in nondiabetic, as well as diabetic patients with end-stage renal disease (ESRD). Increased glucosylation of serum proteins and structural proteins has been documented in patients with diabetes mellitus, but not previously in ESRD. Increased levels of hemoglobin A1 have been reported in patients with ESRD, but appear to be due to carbamylation of hemoglobin rather than glucosylation. Using an assay that does not detect carbamylation, the present study demonstrates abnormally elevated levels of nonenzymatically glucosylated whole-serum proteins in all the chronic hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients studied. Further, we found no change in levels of these abnormal proteins when patients were changed from hemodialysis with a dialysate that contained no glucose to one that did, or to CAPD in which large amounts of glucose are absorbed from the dialysate. The mode of dialysis does not appear to affect glucosylated protein levels in ESRD.