Advanced glycation end-products and arterial stiffness in patients with diabetic nephropathy and patients with chronic kidney disease without diabetes

Abstract

INTRODUCTION: Formation of advanced glycation end-products (AGEs) is increased in diabetic patients. Impaired renal function also elevates AGE accumulation. Pulse wave velocity (PWV) is a measure of arterial stiffness and a prognostic parameter. An association between AGEs and arterial stiffness was observed in hemodialyzed patients. OBJECTIVES: We investigated the relationship between plasma AGE concentration and arterial stiffness in nondialyzed patients with diabetic nephropathy and those with chronic kidney disease (CKD) without diabetes. PATIENTS AND METHODS: PWV measurement was performed in 24 patients with CKD and diabetic nephropathy (DN), 36 patients with CKD and without diabetes, and 19 controls. To assess AGE concentra-tions, plasma fluorescence spectra were recorded. RESULTS: Patients with and without diabetes did not differ with respect to the glomerular filtration rate (33 ± 13 vs. 32 ± 14 ml/min/1.73 m2, respectively). The AGE concentration was significantly higher in patients with DN compared with those without diabetes and controls (21.1 ± 6.8 vs. 12.3 ± 3.1 vs. 7.8 ± 1.2 AU/ml, respectively; P < 0.001). PWV was also significantly higher in patients with DN compared with those without diabetes and controls (13.7 ± 4.3 vs. 10.1 ± 2.4 vs. 8.4 ± 1.6 m/s, respectively; P < 0.05). A significant correlation was found between AGEs and PWV ( r = 0.39, P < 0.01) in patients with CKD. In a multiple regression analysis, PWV was independently associated with age, DN, and systolic blood pressure, but not with AGEs ( R2 = 0.45). CONCLUSIONS: Accumulation of AGEs and arterial stiffness are increased in patients with CKD, particularly in those with DN; however, the results are not sufficient to confirm the causal role of AGE accumulation in arterial stiffening in CKD. AGEs should be considered as a potential therapeutic target in patients with CKD. Copyright by Medycyna Praktyczna, 2013.