Advanced glycation end products and mortality in hemodialysis patients

Schwedler, Susanne; Metzger, Thomas; Schinzel, Reinhard; Wanner, Christoph

doi:10.1046/j.1523-1755.2002.00423.x

Cited by 186 publications

(161 citation statements)

References 33 publications

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“…Previous studies in which AGE levels were estimated in plasma have reported ambiguous results regarding the association between AGE levels and mortality 35, 36. Conversely, the results of this meta‐analysis show that SAF is consistently associated with mortality.…”

Section: Discussioncontrasting

confidence: 53%

Skin Autofluorescence–Indicated Advanced Glycation End Products as Predictors of Cardiovascular and All‐Cause Mortality in High‐Risk Subjects: A Systematic Review and Meta‐analysis

Cavero‐Redondo

Soriano-Cano

Álvarez‐Bueno

et al. 2018

JAHA

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BackgroundChronic deposits of advanced glycation end products produced by enzymatic glycation have been suggested as predictors of atherosclerotic‐related disorders. This study aimed to estimate the relationship between advanced glycation end products indicated by skin autofluorescence levels and the risk of cardiovascular and all‐cause mortality based on data from observational studies.Methods and ResultsWe systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and the Web of Science databases from their inceptions until November 2017 for observational studies addressing the association of advanced glycation end products by skin autofluorescence levels with cardiovascular and all‐cause mortality. The DerSimonian and Laird random‐effects method was used to compute pooled estimates of hazard ratios and their respective 95% confidence intervals for the risk of cardiovascular and all‐cause mortality associated with levels of advanced glycation end products by skin autofluorescence. Ten published studies were included in the systematic review and meta‐analysis. Higher skin autofluorescence levels were significantly associated with a higher pooled risk estimate for cardiovascular mortality (hazard ratio: 2.06; 95% confidence interval, 1.58–2.67), which might not be important to moderate heterogeneity (I2=34.7%; P=0.163), and for all‐cause mortality (hazard ratio: 1.91; 95% confidence interval, 1.42–2.56) with substantial heterogeneity (I2=60.8%; P=0.0.18).ConclusionsOur data suggest that skin autofluorescence levels could be considered predictors of all‐cause mortality and cardiovascular mortality in patients at high and very high risk.

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Section: Discussioncontrasting

confidence: 53%

Skin Autofluorescence–Indicated Advanced Glycation End Products as Predictors of Cardiovascular and All‐Cause Mortality in High‐Risk Subjects: A Systematic Review and Meta‐analysis

Cavero‐Redondo

Soriano-Cano

Álvarez‐Bueno

et al. 2018

JAHA

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“…Poor glycemic control might result directly in macrovascular complications, possibly secondary to the generation of advanced glycation end products (AGEs), and hence shorten survival of these patients. However, higher AGE levels in 312 hemodialysis patients were found to be paradoxically associated with better survival (30). Whether the benefit of high serum AGEs in these types of observational studies is an epiphenomenon or reflects a better nutritional status needs further study.…”

Section: Discussionmentioning

confidence: 97%

Glycemic Control and Survival in Peritoneal Dialysis Patients with Diabetes Mellitus

Duong

Mehrotra

Molnar

et al. 2011

Clinical Journal of the American Society of Nephrology

132

103

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Summary Background and objectives The optimal target for glycemic control has not been established for diabetic peritoneal dialysis (PD) patients. Design, setting, participants, & measurements We examined mortality-predictability of hemoglobin A1c random serum glucose in a contemporary cohort of diabetic PD patients treated in DaVita dialysis clinics July 2001 through June 2006 with follow-up through June 2007. Results We identified 2798 diabetic PD patients with A1c data. Serum glucose correlated with A1C (r = 0.51). Adjusted all-cause death hazard ratio and 95% confidence interval for baseline A1c increments of 7.0 to 7.9%, 8.0 to 8.9%, 9.0 to 9.9%, and ≥10%, compared with 6.0 to 6.9% (reference), were 1.13 (0.97 to 1.32), 1.05 (0.88 to 1.27), 1.06 (0.84 to 1.34), and 1.48 (1.18 to 1.86); and for time-averaged A1c values were 1.10 (0.96 to 1.27), 1.28 (1.07 to 1.53), 1.34 (1.05 to 1.70), and 1.81 (1.33 to 2.46), respectively. The A1c-mortality association was modified by hemoglobin level such that higher all-cause mortality was evident only in nonanemic patients. Similar but non-significant trends in cardiovascular death risk was found across A1c increments. Adjusted all-cause death HR for time-averaged blood glucose 150 to 199, 200 to 249, 250 to 299, and ≥300 mg/dl, compared with 60 to 99 mg/dl (reference), were 1.02 (0.70 to 1.47), 1.12 (0.77 to 1.63), 1.45 (0.97 to 2.18), and 2.10 (1.37 to 3.20), respectively. Conclusions Poor glycemic control appears associated incrementally with higher mortality in PD patients. Moderate to severe hyperglycemia is associated with higher death risk especially in certain subgroups.

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“…Schwedler et al (36) and Busch et al (37) reported that circulating AGE do not predict mortality in HD patients. However, serum AGE may be influenced by dialysis modalities, absorption from food, and smoking (38 -40).…”

Section: Discussionmentioning

confidence: 99%

Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Predicts Mortality in Hemodialysis Patients

Meerwaldt

Hartog²,

Graaff³

et al. 2005

Journal of the American Society of Nephrology

344

365

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Tissue advanced glycation end products (AGE) are a measure of cumulative metabolic stress and trigger cytokines driven inflammatory reactions. AGE are thought to contribute to the chronic complications of diabetes and ESRD. Tissue autofluorescence is related to the accumulation of AGE. Therefore, skin autofluorescence (AF) may provide prognostic information on mortality in hemodialysis (HD) patients. Skin AF was measured noninvasively with an AF reader at baseline in 109 HD patients. Overall and cardiovascular mortality was monitored prospectively during a period of 3 yr. The AF reader was validated against AGE contents in skin biopsies from 29 dialysis patients. Forty-two of the 109 (38.5%) HD patients died. Cox regression analysis showed that AF was an independent predictor of overall and cardiovascular mortality (for overall mortality odds ratio [OR] 3.9), as were pre-existing cardiovascular disease (CVD; OR 3.1), C-reactive protein (OR 1.1), and serum albumin (OR 0.3). Multivariate analysis revealed that 65% of the variance in AF could be attributed to the independent effects of age, dialysis and renal failure duration, presence of diabetes, triglycerides levels, and C-reactive protein. AF was also independently linked to the presence of CVD at baseline (OR 8.8; P < 0.001). AF correlated with collagen-linked fluorescence (r ‫؍‬ 0.71, P < 0.001), pentosidine (r ‫؍‬ 0.75, P < 0.001), and carboxy(m)ethyllysine (both r ‫؍‬ 0.45, P < 0.01). Skin AF is a strong and independent predictor of mortality in ESRD. This supports a role for AGE as a contributor to mortality and CVD and warrants interventions specifically aimed at AGE accumulation.

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Advanced glycation end products and mortality in hemodialysis patients

Cited by 186 publications

References 33 publications

Skin Autofluorescence–Indicated Advanced Glycation End Products as Predictors of Cardiovascular and All‐Cause Mortality in High‐Risk Subjects: A Systematic Review and Meta‐analysis

Skin Autofluorescence–Indicated Advanced Glycation End Products as Predictors of Cardiovascular and All‐Cause Mortality in High‐Risk Subjects: A Systematic Review and Meta‐analysis

Glycemic Control and Survival in Peritoneal Dialysis Patients with Diabetes Mellitus

Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Predicts Mortality in Hemodialysis Patients

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