Advanced glycation end-products and skin autofluorescence in end-stage renal disease: a review

Abstract

Chronic kidney disease (CKD), especially in its end stage, is marked by extremely high cardiovascular rates of morbidity and mortality; hemodialysis patients have a five-fold shorter life expectancy than healthy subjects of the same age. In CKD the metabolic products that accumulate in the body are so-called uremic toxins. These include advanced glycation end-products (AGE). AGE levels are markedly increased in CKD patients not only because of impaired excretion but also because of increased production. AGE formation has initially been described as a non-enzymatic reaction between proteins and glucose in the so-called Maillard reaction, but they are also more rapidly formed during oxidative stress and subsequent formation of reactive carbonyl compounds like (methyl)glyoxal. AGE accumulate in tissue where they cross-link with proteins, e.g., collagen, inducing tissue stiffening of blood vessels and skin. They may also interact with receptor of AGE (RAGE) and other receptors, which lead to activation of intracellular transduction mechanisms resulting in cytokine release and further tissue damage in CKD. The accumulation of AGE in the skin can be measured non-invasively using autofluorescence. The skin autofluorescence is a strong marker of cardiovascular mortality in CKD. The focus of this review is on the role of tissue and plasma AGE, and of skin autofluorescence as a proxy of tissue AGE accumulation, in the increase in cardiovascular disease in end stage renal disease (ESRD). This review will also present the possibility of reducing the AGE accumulation in ESRD patients using the following five methods: 1) use of low AGE peritoneal dialysis solutions; 2) use of advanced hemodialysis techniques; 3) use of AGE reducing drugs; 4) optimizing the nutrition of hemodialysis patients; and 5) renal transplantation.

Glycation: Implication in Perceived Age and Dermatology

“…The DCCT-EDIC (The Diabetes Control and Complications Trial-Epidemiology of Diabetes Interventions and Complications) highlighted the fact that AGEs are an independent predictor of worse renal and cardiovascular disease (59,115).…”

“…Chronic kidney disease comprises a wide spectrum of abnormalities, including progressive loss of renal function, but also an important increase in cardiovascular disease (CVD) and premature death (59).…”

A bőr-autofluoreszcencia és a konvencionális glykaemiás markerek kapcsolata diabeteses betegekben

“…Veseelégtelen betegekben megfi gyelhető szintnövekedésük nemcsak a renalis elimináció miatti passzív folyamat, hanem a termelődésük is fokozottabb az oxidatív folyamatok nagyobb intenzitása miatt (Maillard-reakció, reaktív karbonilmetabolitok, metil-glioxál). Dializált betegekben az AGE szöveti szintjének noninvazív mérése révén felismert magas cardiovascularis rizikójú betegek esetében a táplálék AGE-tartalmának csökkentése, alacsony AGE-expozíciót jelentő peritonealis dializálóoldatok bevezetése, jobb kö-zépmolekula-eltávolítást lehetővé tevő hemodialízistech-nikák alkalmazása javíthat a további prognózison [29].…”

Association of Serum Soluble Receptor for Advanced Glycation End Products (sRAGE), S100A12, and VCAM-1 Levels with Further Post-Coronary Angiogram Endothelial Injury in Elderly and Younger Patients

“…RAGE (Receptor for Advanced Glycation End Products) belongs to the immunoglobulin super family and is expressed upon appearance of endothelial, lymphocytes as well as smooth muscle cells [1]. Full-length, N-truncated as well as C-truncated soluble RAGEs are typical RAGEs [2] [3] [4].…”