Metabolism of parenteral glucose oligosaccharides in man

Patient Tolerance and Dialysis Effectiveness of a Glucose Pol YMER-containing Peritoneal Dialysis Solution

A polymer of glucose was tested for use as an osmotically active agent in peritoneal dialysis. The osmotic effect of the polymer is more prolonged and more effective than that of glucose. Comparison of the relative caloric loads of the polymers compared to glucose awaits documentation of the rate of uptake of the polymer and its rate of metabolism to glucose.

Osmotically active agents are necessary in peritoneal dialysates in order to achieve ultrafiltration of plasma water into the dialysate. Osmotically active agents also increase the total clearance of solutes such as urea and creatinine both by solvent drag, or convective fluid movement (1), as well as by causing vasodilatation of the peritoneal vessels, increasing blood flow and perhaps increasing the dialysis surface area (2), and by increasing pefllleability (3). To be useful as an osmotic agent, a substance must be non-toxic, should be of sufficient molecular size to remain in the peritoneal space, and any of the agent which is taken up into the systemic circulation should be metabolizable.

A randomized multicenter clinical trial comparing isosmolar icodextrin with hyperosmolar glucose solutions in CAPD. MIDAS Study Group. Multicenter Investigation of Icodextrin in Ambulatory Peritoneal Dialysis

The osmotic effectiveness of a large molecular weight glucose polymer fraction (Icodextrin) as a novel "colloid" osmotic agent in peritoneal dialysis was established, but the long-term safety remained undetermined. A randomized, controlled multicenter investigation of Icodextrin in ambulatory peritoneal dialysis (MIDAS) was undertaken to evaluate the long-term safety and efficacy by comparing daily overnight (8 to 12 hr dwell) use of isosmolar Icodextrin (282 mOsm/kg) with conventional 1.36% (346 mOsm/kg) and 3.86% (484 mOsm/kg) glucose exchanges over six months. Two hundred and nine patients were randomized from 11 centers, with 106 allocated to receive Icodextrin (D) and 103 to remain on glucose (control group; C); 138 patients completed the six month study (71 C, 67 D). All patients were divided into weak (1.36%) or strong (3.86%) subgroups based on their use of glucose solutions overnight during the pretreatment baseline period. The mean (+/- SEM) overnight ultrafiltration (UF) with D was 3.5 times greater than 1.36% glucose at eight hours [527 +/- 36 vs. 150 +/- 47 ml; 95% confidence interval (CI) for the difference +257 to +497 ml; P < 0.0001] and 5.5 times greater at 12 hours (561 +/- 44 vs. 101 +/- 48 ml, 95% CI for the difference +329 to +590; P < 0.0001) and no different from that of 3.86% glucose at eight hours (510 +/- 48 vs. 448 +/- 60 ml, 95% CI for the difference -102 to +226 ml; P = 0.44) and at 12 hours (552 +/- 44 vs. 414 +/- 78 ml, 95% CI for the difference -47 to +325 ml; P = 0.06).(ABSTRACT TRUNCATED AT 250 WORDS)

Source of the urinary maltose and maltotriose excreted during intravenous infusion of oligosaccharide solutions in young pigs

Pigs infused with preparations of glucose oligosaccharides excrete sizeable quantities of maltose in urine despite the absence of maltose in the infused solution. Maltose infused without other oligosaccharides is well utilized. Our studies examined possible sources of excreted maltose. We first examined whether simultaneous infusion of larger oligosaccharides with maltose inhibits maltose utilization. Four young pigs were infused for four days with 20 g/d of a maltose-free oligosaccharide preparation to which tracer quantities of U-14C-maltose were added. Urinary excretion of maltose-plus-maltotriose increased significantly (P less than .05) from a mean +/- SD baseline value of .01 +/- .01 g/d to an overall four-day mean value of 1.33 +/- 0.47 g/d. However, only 10.7 +/- 0.78% of infused 14C-maltose was excreted, indicating that simultaneous infusion of larger oligosaccharides did not inhibit maltose utilization. The second study examined whether maltotriose present in the oligosaccharide mixture was the source of excreted maltose. Four young pigs were infused for three days with 20 g/d of a special preparation of oligosaccharides containing only trace quantities of maltose and maltotriose. Urinary maltose plus maltotriose excretion increased significantly (P less than .05) from a mean +/- SD baseline value of .01 +/- .01 g/d to 1.65 +/- 0.41 g/d during oligosaccharide infusion. The data suggest that excreted maltose and maltotriose arise from the catabolism of larger oligosaccharides.

Method for evaluating utilization of infused oligosaccharides in postsurgical patients

Oligosaccharides are potential sources of carbohydrate-derived energy for use in parenteral nutrition regimens. Clinical studies indicate that although some patients utilize infused oligosaccharides well, many patients do not. These results suggest that oligosaccharides might be useful as a parenteral energy source for selected patients. This report describes a method, suitable for use by nursing staff on the ward, to determine oligosaccharide utilization and identify patients utilizing oligosaccharides well. Oligosaccharides excreted in urine are hydrolyzed enymatically to glucose using alpha-glucosidase and alpha-amylase, and the glucose released is measured by a test tape method. The results obtained agree well with the acid hydrolysis-spectrophotometric assay for oligosaccharide excretion used in earlier studies. The method readily identified postsurgical patients utilizing infused oligosaccharides poorly in both prospective and retrospective studies.

Utilization of parenterally administered glucose oligosaccharides when infused with glucose and amino acids in postsurgical patients

Utilization of intravenously administered oligosaccharides was tested in postsurgical patients by infusing them simultaneously with glucose and amino acids. Thirty two patients were infused with one of two parenteral regimens for four-day periods. Twenty-two patients received a nutritional regimen providing 46 g glucose, 32.5 g amino acids, and 45 g oligosaccharides per liter, while the remaining ten patients received the same solution without oligosaccharides. Patients infused with the test solution received an overall four-day mean +/- SD of 106 +/- 24.2 g oligosaccharide per day. The mean overall four-day excretion of total glucose (free plus oligosaccharide bound) was significantly higher (P less than 0.001) in patients infused with oligosaccharides (46.1 +/- 29.0 g/d) than in reference patients (1.19 +/- 1.20 g/d). Of the total carbohydrate excreted in patients receiving oligosaccharides, 11.3 +/- 13.1 g/d were glucose, 14.8 +/- 13.1 g/d were maltose plus maltotriose, and 20.8 +/- 19.3 g/d were oligosaccharides of maltotetraose size or larger. Although overall utilization of infused oligosaccharide for all patients was only 58.5% +/- 23.1%, three of the patients showed unexpectedly good utilization (94.6% +/- 1.24%).

Evaluation of a peritoneal dialysis solution containing polymer

Glucose is used in peritoneal dialysate to produce the gradient for ultrafiltration. The peritoneal membrane's low reflection coefficient for glucose imposes a demand for high transmembrane concentrations, perhaps adding unwanted body burden of glucose. A polymer with a lower permeation rate used as an osmotic agent would circumvent this. We evaluated the mass transfer coefficient (mtc), T1/2 disappearance from the peritoneal cavity and ultrafiltration capabilities of a 900 dalton (Mn) starch derived polymer. We compared an 8% (455 mOsm/L) and a 10% (484 mOsm/L) polymer (Pol) solution to available dialysate solutions containing 2.5% (399 mOsm/L) and 4.25% (491 mOsm/L) X glucose (Glc). The dialysate compositions were otherwise similar. Using a randomized complete block design, 5 anephric dogs maintained on chronic peritoneal dialysis were studied. The mtc (ml/min) was greater for the glucose than the polymer solutions (p less than 0.05): 2.5%-13 and 4.25%-14 vs 8%-5 and 10%-6. The T1/2 disappearance (min) was also greater (p less than 0.05): 2.5% Glc-112 and 4.25% Glc-111 vs 8% Pol-281 and 10% Pol-252. Over a 180 min. period the 2.5% glucose solution generated the least volume of ultrafiltrate (ml, p less than 0.05): 2.5% Glc-113 and 4.25% Glc-589 vs 8% Pol-640; 10% Pol-912. We conclude that the lower permeation rate of the polymer yields ultrafiltration at a lower dialysate osmolality. A polymer solution may be a feasible alternative to glucose.