Low molecular weight advanced glycation end products predict mortality in asymptomatic patients receiving chronic haemodialysis

• Published in: Nephrology, dialysis, transplantation Vol. 21; no. 6; pp. 1611 - 1617
• Main Authors: Roberts, Matthew A., Thomas, Merlin C., Fernando, Dharsh, Macmillan, Neil, Power, David A., Ierino, Francesco L.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-06-2006; Oxford Publishing Limited (England)
• Subjects: advanced glycation end products; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - etiology; Emergency and intensive care: renal failure. Dialysis management; Female; Fluorescence; Glycation End Products, Advanced - blood; haemodialysis; Humans; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Male; Medical sciences; Middle Aged; Molecular Weight; Mortality; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Predictive Value of Tests; Prospective Studies; Renal Dialysis; Renal failure; ROC Curve; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Kidney disease; Human; Extrarenal dialysis; Urinary system disease; Hemodialysis; Mortality; Renal failure; haemodialysis; Asymptomatic; advanced glycation end products; Glycation
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfl053

Background. Advanced glycation end products (AGEs) have biological properties that may contribute to the premature cardiovascular mortality of haemodialysis patients. This study examines the hypothesis that low molecular weight forms of fluorescent AGEs (LMW fluorescence) predict mortality in haemodialysis patients. Methods. The LMW fluorescence was measured in 85 patients treated with chronic haemodialysis and prospectively followed for 4 years. The primary outcome of all-cause mortality was assessed using Cox proportional hazards regression model. Results. At the end of the follow-up period 37 (44%) patients died. The median LMW fluorescence level was 24.2 arbitrary units (range: 10.6–148.1 AU) and the receiver operator characteristic (ROC) curve cut-off for mortality was 37.0 AU. The LMW fluorescence predicted death both as a binary variable at the ROC cut-off, and as a continuous log-transformed variable when adjusted for age, albumin and C-reactive protein (CRP). Adjusted for age, albumin and CRP, the hazard ratio for mortality was 3.05 (1.41–6.60, P = 0.005) for LMW fluorescence as a binary variable and 2.71 per log unit (1.37–5.38, P = 0.004) as a continuous log-transformed variable. Conclusion. The low molecular weight forms of AGEs predict mortality in patients receiving chronic haemodialysis, and may be important in the mechanisms leading to atherosclerosis and inflammation in such patients.