Advanced Glycation End Products and Renal Failure.

This article reviews evidence that advanced glycation end products (AGEs) play a role in the pathogenesis of cardiovascular disease in patients with end-stage renal disease. AGEs, which are known to be atherogenic, accumulate in patients whose kidneys lack the capacity to excrete them. Hemodialysis is relatively ineffective at clearing AGEs from the plasma (peritoneal dialysis is somewhat more effective), so hemodialysis patients have extremely high AGE levels. The concentration of AGEs in the skin is a stronger predictor of mortality in patients on hemodialysis than is smoking and serum cholesterol levels.

Comment: AGEs form in vivo from reactions between a reducing sugar (e.g., glucose or fructose) and proteins. AGEs are also present in varying amounts in some foods, and about 10% of dietary AGEs are absorbed into the bloodstream. In a study of patients with renal failure receiving peritoneal dialysis, restriction of dietary AGE intake (primarily by altering cooking methods) significantly decreased serum AGE concentrations, thereby potentially decreasing the risk of cardiovascular disease. Presumably, decreasing AGE intake would also reduce serum AGE levels in hemodialysis patients. Emphasizing boiling, poaching, and stewing over frying, broiling, and roasting decreases AGE intake by up to 50%.

Meerwaldt R, Zeebregts CJ, Navis G, Hillebrands JL, Lefrandt JD, Smit AJ. Accumulation of advanced glycation end products and chronic complications in ESRD treated by dialysis. Am J Kidney Dis. 2009;53:138-150.

by Alan R. Gaby, MD

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