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. uorescence) predict mortality in haemodialysis patients. Methods. The LMW. uorescence 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. uorescence level was 24.2 arbitrary units (range: 10.6 - 148.1 AU) and the receiver operator characteristic (ROC) curve cutoff for mortality was 37.0 AU. The LMW. uorescence 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. uorescence 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 in. ammation in such patients.