Consistently Low Serum Levels of MG-H1 Are Associated With a Lower Risk of Diabetic Kidney Disease

Abstract

Context: Diabetic kidney disease (DKD) is associated with an increased risk of cardiovascular events, end-stage renal disease, and mortality. Advanced glycation end products (AGEs) are related to DKD. However, data on the associations between long-term changes in AGEs and DKD are lacking. Objective: We aimed to ascertain whether a long-term shift in serum AGE levels is associated with DKD development and progression in patients with poorly controlled diabetes. Methods: The serum levels of the AGE, methylglyoxal-derived hydroimidazolone-1 (MG-H1) were measured twice in 160 patients with diabetes. We categorized patients whose serum MG-H1 levels were <2.5 µg/mL at both measurements as the consistently low MG-H1 group. The primary endpoints were new or worsening DKD, which was defined as the occurrence of either a 30% decline in estimated glomerular filtration rate (eGFR), doubling of serum creatinine, development of macroalbuminuria, need for renal replacement therapy, or death due to renal disease. Hazard ratios (HRs) for new or worsening DKD, with 95% confidence intervals (CIs), were calculated using Cox proportional hazard models to compare the outcomes between the consistently low MG-H1 group and the other group. Results: Compared to the other group, the consistently low MG-H1 group had a significantly lower risk of new or worsening DKD, after adjusting for possible confounders (HR: 0.48; 95% CI, 0.29–0.81; P = .01). Furthermore, the same relationship was observed in patients without eGFR <30 mL/min/1.73 m2, advanced DKD, or cardiovascular events. Conclusion: Consistently low serum MG-H1 levels are associated with a lower frequency of DKD.