Advanced glycosylation end products in continuous ambulatory peritoneal dialysis patients

Low molecular weight advanced glycosylation end products (AGEs) were evaluated for by an enzyme-linked immunosorbent assay in 30 patients on continuous ambulatory peritoneal dialysis (29 patients) and continuous cyclic peritoneal dialysis (one patient). Thirteen patients were diabetic and 17 patients were nondiabetic. All patients underwent peritoneal equilibration tests and, in addition to routine chemistries, serum and dialysate were evaluated for AGEs. Serum creatinine levels were similar in the diabetic and nondiabetic patients, but serum AGE levels were significantly higher in the diabetic patients (16.2 +/- 5.3 v 8.2 +/- 2.3 U/mL; P < 0.0001). Overall, the dialysate to plasma ratio at 4 hours was 0.69 +/- 0.08 for creatinine and 0.18 +/- 0.06 for AGEs. The mass transfer area coefficient for all patients was 12.4 +/- 3.12 mL/min for creatinine and 2.03 +/- 0.93 mL/min for AGEs. The peritoneal transport of AGEs as measured by dialysate to plasma ratios at 4 hours and by mass transfer area coefficients was significantly less (P < 0.001) than that for creatinine. No significant difference in dialysate to plasma ratios or mass transfer area coefficient for creatinine or AGEs was noted between diabetic and nondiabetic patients. The peritoneal transport of AGEs is poor and leads to elevated serum levels, especially in patients with diabetes mellitus. The accumulation of AGEs may contribute to the increased cardiovascular mortality seen in patients with end stage renal disease. This is most marked in patients with diabetes mellitus.