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


CONCLUSIONS
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.
Roberts
Matthew A
MA
Department of Nephrology, Austin Health, Heidelberg 3084, Victoria, Australia.
Thomas
Merlin C
MC
Fernando
Dharsh
D
Macmillan
Neil
N
Power
David A
DA
Ierino
Francesco L
FL
D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005453:Fluorescence; D017127:Glycation End Products, Advanced / Q000097:blood*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D009026:Mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D006435:Renal Dialysis
D017127:Glycation End Products, Advanced