title: Restriction of dietary glycotoxins reduces excessive advanced glycation end products in renal failure patients.
abstract: Advanced glycation endproduct (AGE) levels are elevated in renal failure patients and may contribute to the excessive cardiovascular disease in this population. Diet-derived AGE are major contributors to the total body AGE pool. It was postulated that a reduction in dietary AGE intake might impact on the high circulating AGE levels in renal failure patients. Twenty-six nondiabetic renal failure patients on maintenance peritoneal dialysis were randomized to either a high or a low AGE diet for 4 wk. Three-day dietary records, fasting blood, 24-h urine, and dialysis fluid collections were obtained at baseline and end of study. AGE levels were determined by ELISA for N(epsilon)-carboxymethyl-lysine (CML) and methylglyoxal-derivatives (MG). Eighteen patients completed the study. Low dietary AGE intake decreased serum CML (34%; P < 0.002), serum MG (35%; P < 0.008), CML-LDL (28%; P < 0.011), CML-apoB (25%; P < 0.028), dialysate CML (39%; P < 0.03), and dialysate MG output (40%; P < 0.04). High dietary AGE intake increased serum CML (29%; P < 0.028), serum MG (26%; P < 0.09), CML-LDL (50%; P < 0.011), CML-apoB (67%; P < 0.028), and dialysate CML output (27%; P < 0.01). Serum AGE correlated with BUN (r = 0.6, P < 0.002 for CML; r = 0.4, P < 0.05 for MG), serum creatinine (r = 0.76, P < 0.05 for CML; r = 0.55, P < 0.004 for MG), total protein (r = 0.4, P < 0.05 for CML; r = 0.4, P < 0.05 for MG), albumin (r = 0.4, P < 0.02 for CML; r = 0.4, P < 0.05 for MG), and phosphorus (r = 0.5, P < 0.006 for CML; r = 0.5, P < 0.01 for MG). It is concluded that dietary glycotoxins contribute significantly to the elevated AGE levels in renal failure patients. Moreover, dietary restriction of AGE is an effective and feasible method to reduce excess toxic AGE and possibly cardiovascular associated mortality.
authors.affiliation: Division of Experimental Diabetes and Aging, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. jaime.uribarri@mssm.edu
authors.forename: Jaime
authors.initials: J
authors.lastname: Uribarri
authors.forename: Melpomeni
authors.initials: M
authors.lastname: Peppa
authors.forename: Weijing
authors.initials: W
authors.lastname: Cai
authors.forename: Teresia
authors.initials: T
authors.lastname: Goldberg
authors.forename: Min
authors.initials: M
authors.lastname: Lu
authors.forename: Cijiang
authors.initials: C
authors.lastname: He
authors.forename: Helen
authors.initials: H
authors.lastname: Vlassara
mesh_terms: D000328:Adult; D004032:Diet; D017127:Glycation End Products, Advanced / Q000009:adverse effects* / Q000493:pharmacokinetics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy* / Q000378:metabolism*; D010530:Peritoneal Dialysis; D012044:Regression Analysis
chemical_list: D017127:Glycation End Products, Advanced