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NDT Advance Access published online on March 6, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl053
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received September 19, 2005
Accepted January 31, 2006

Original Article

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

Matthew A. Roberts 1, Merlin C. Thomas 2, Dharsh Fernando 3, Neil Macmillan 4, David A. Power 1, and Francesco L. Ierino 1 *

1 Department of Nephrology, Austin Health, Heidelberg, and Department of Medicine, University of Melbourne, Victoria, Australia
2 Division of Diabetic Complications, Baker Medical Research Institute, Melbourne, Australia
3 Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
4 Division of Laboratory Medicine, Austin Health, Heidelberg, Victoria, Australia

* To whom correspondence should be addressed.
Francesco L. Ierino, E-mail: Frank.IERINO{at}austin.org.au



  Abstract

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.

Keywords: advanced glycation end products; haemodialysis; mortality.
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