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ORIGINAL ARTICLES |
1 Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden; 2 Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland
Correspondence to: B. Lindholm, K-56 Baxter Novum and Renal Medicine, Karolinska University Hospital at Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden. bengt.lindholm{at}ki.se
Background: Plasma 
-amylase activity is elevated
in uremic patients but lower in peritoneal dialysis (PD) patients using
icodextrin in comparison to healthy controls. We studied the rate by which an
exogenous oligosaccharide (maltoheptaose; G7) is degraded ex vivo by
amylase in plasma from PD patients treated with glucose or icodextrin PD
solutions. Methods: Plasma amylase (pancreatic and total) activity
and concentration were measured in 11 controls and in PD patients treated with
glucose (n = 11) and icodextrin (n = 19). The plasma was
spiked with G7 and/or synthetic amylase and the metabolites formed were
measured by HPLC following incubation at 37°C for 4 hours. Results: The relationship between amylase activity and
amylase concentration was similar in all patients and controls. The G7
degradation rate was slower in plasma from icodextrin patients but it was also
reduced in patients using glucose compared with the controls, in spite of the
higher amylase activity in the glucose group. Normalization (by spiking) of
patient plasma with porcine amylase increased but did not normalize the speed
of G7 degradation. At a given endogenous amylase activity level, the
efficiency of G7 degradation was similar for both patient groups. Conclusions: An ex vivo model to study the
relationship between amylase activity and the actual rate of carbohydrate
(represented by G7) breakdown was developed and showed that PD patients using
glucose and icodextrin degrade G7 at a slower speed than controls. This
suggests that amylase-mediated carbohydrate metabolism is reduced in PD
patients. Further clinical studies are needed to confirm if these findings
hold true also in other groups of uremic patients with varying degrees of
kidney failure, as well as in patients undergoing hemodialysis.
KEY WORDS: Icodextrin; amylase; maltoheptaose.
Received 27 August 2007; accepted 24 November 2007.
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