title: Serum carboxymethyllysine predicts mortality in hemodialysis patients.
abstract: BACKGROUND
  Hemodialysis patients show markedly elevated serum levels of advanced glycation end products (AGEs). AGEs have been implicated in the pathogenesis of vascular damage and are regarded as a class of uremic toxins. However, to date, serum AGE level could not be identified as an independent predictor of mortality. The aim of the present study is to test whether serum level of the AGE carboxymethyllysine (CML) predicts all-cause or cardiovascular mortality in hemodialysis patients.
  
  
  METHODS
  Serum total CML concentration was measured by means of enzyme-linked immunosorbent assay in 154 patients receiving long-term hemodialysis. Patients were divided into groups with serum CML levels less and greater than the median (23.8 ng/mg protein). All-cause and cardiovascular mortality were registered during a follow-up of 51 months. The relationship between serum CML level and mortality was tested by using Kaplan-Meier and Cox regression analyses.
  
  
  RESULTS
  In the group with low serum CML levels, 38% of patients died during the follow-up period; 23% had a cardiovascular cause of death. However, in the group with high CML levels, 58% died (P < 0.01) and 36% had a cardiovascular cause of death (P < 0.05). The following parameters proved to be independent risk factors of all-cause mortality: age (hazard ratio, 1.056; P < 0.001), preexisting vascular disease (hazard ratio, 2.53; P < 0.05), smoking (hazard ratio, 3.03; P < 0.005), high serum CML level (hazard ratio, 1.776; P < 0.05), and C-reactive protein level (hazard ratio, 1.017; P < 0.001).
  
  
  CONCLUSIONS
  The AGE CML may contribute to increased mortality in patients with uremia.
authors.affiliation: Second Department of Medicine, Nephrological Center, University of Pécs, Pécs, Germany. zoltan.wagner@aok.pte.hu
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Wagner
authors.forename: Márta
authors.initials: M
authors.lastname: Molnár
authors.forename: Gergo A
authors.initials: GA
authors.lastname: Molnár
authors.forename: Mónika
authors.initials: M
authors.lastname: Tamaskó
authors.forename: Boglárka
authors.initials: B
authors.lastname: Laczy
authors.forename: László
authors.initials: L
authors.lastname: Wagner
authors.forename: Botond
authors.initials: B
authors.lastname: Csiky
authors.forename: August
authors.initials: A
authors.lastname: Heidland
authors.forename: Judit
authors.initials: J
authors.lastname: Nagy
authors.forename: István
authors.initials: I
authors.lastname: Wittmann
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008239:Lysine / Q000031:analogs & derivatives* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: C048496:N(6)-carboxymethyllysine; D008239:Lysine