Reduction of advanced glycation end product levels by on-line hemodiafiltration in long-term hemodialysis patients

Lin, Chun‐Liang; Huang, Chiu‐Ching; Yu, Chung-Chieh; Yang, Huang‐Yu; Chuang, Feng‐Rong; Yang, Chih‐Wei

doi:10.1016/s0272-6386(03)00747-9

Cited by 72 publications

(56 citation statements)

References 27 publications

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“…Membranes with high permeability can, therefore, decrease blood AGEs by up to 60% 164 and up to 80% with high-flux polysulfone. 165,166 Lin et al 167 showed that online hemodiafiltration, a combination of both HF and HD, for .6 months in patients with uremia leads to a significant reduction in serum AGE levels. A recent study showed that convective therapies not only effectively cleared uremic toxins but also, decreased levels of inflammatory markers, such as IL-6.…”

Section: Inhibition Of Gastrointestinal Absorptionmentioning

confidence: 99%

Uremic Toxicity of Advanced Glycation End Products in CKD

Stinghen

Massy

Vlassara

et al. 2016

Journal of the American Society of Nephrology

192

175

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Advanced glycation end products (AGEs), a heterogeneous group of compounds formed by nonenzymatic glycation reactions between reducing sugars and amino acids, lipids, or DNA, are formed not only in the presence of hyperglycemia, but also in diseases associated with high levels of oxidative stress, such as CKD. In chronic renal failure, higher circulating AGE levels result from increased formation and decreased renal clearance. Interactions between AGEs and their receptors, including advanced glycation end product-specific receptor (RAGE), trigger various intracellular events, such as oxidative stress and inflammation, leading to cardiovascular complications. Although patients with CKD have a higher burden of cardiovascular disease, the relationship between AGEs and cardiovascular disease in patients with CKD is not fully characterized. In this paper, we review the various deleterious effects of AGEs in CKD that lead to cardiovascular complications and the role of these AGEs in diabetic nephropathy. We also discuss potential pharmacologic approaches to circumvent these deleterious effects by reducing exogenous and endogenous sources of AGEs, increasing the breakdown of existing AGEs, or inhibiting AGE-induced inflammation. Finally, we speculate on preventive and therapeutic strategies that focus on the AGE-RAGE axis to prevent vascular complications in patients with CKD.

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Section: Inhibition Of Gastrointestinal Absorptionmentioning

confidence: 99%

Uremic Toxicity of Advanced Glycation End Products in CKD

Stinghen

Massy

Vlassara

et al. 2016

Journal of the American Society of Nephrology

192

175

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“…Also, single dialysis session with on-line hemodiafiltration (HDF) results in lower plasma AGE than with those treated with conventional low and high flux HD. The longterm use of HDF provides lower predialysis plasma AGE levels compared with those treated with low and high flux HD [42].…”

Section: Use Of Advanced Hemodialysis Techniquesmentioning

confidence: 99%

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

Arsov¹,

Graaff

Oeveren

et al. 2014

Clinical Chemistry and Laboratory Medicine

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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.

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“…Higher clearances of a number of other uremic compounds have also been documented with HDF: complement factor D (a proinflammatory mediator), leptin (16 kDa; involved in loss of appetite), FGF23 (30 kDa, implicated in metabolic bone disorders and vascular calcification), various cytokines, circulating advanced glycosylation end products (AGEs), and AGE precursors [43,44].…”

Section: Solute Removal: Phosphate β2-microglobulinmentioning

confidence: 99%

Update on Clinical Evidence Supporting Hemodiafiltration

Canaud¹,

Grassmann²,

Scatizzi³

et al. 2016

Advances in Hemodiafiltration

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The aim of this chapter is to define hemodiafiltration target efficiency, to clarify the concept of "optimal convective dose," and to facilitate hemodiafiltration (HDF) implementation in clinical practice by addressing the need for the establishment of best clinical practices for HDF. The approach taken was to conduct a comprehensive summary of clinical evidence supporting HDF. Convective dose is the total ultrafiltered volume and is complementary to diffusive dose (urea Kt/V) as a dose-dependent parameter. It can be quantified and adjusted to patient characteristics. Factors affecting convective dose are discussed: patient characteristics, prescription-dependent factors, and technical and machine-dependent factors. The key issue of HDF prescription and implementation of best practices is addressed as are intermediary and endpoint clinical outcomes. The main messages are as follows: (1) HDF is safe and effective provided that best clinical practices are followed and the right convective dose is delivered; (2) HDF is easy to perform with new technology; and (3) depending on the convection volume, HDF reduces all-cause and cardiovascular mortality. Open challenges remain, namely, the implementation of best practices to (a) achieve optimal convection volume, (b) define patient subsets that would benefit more from HDF, and (c) evaluate new tools that fine-tune HDF prescription according to individual patient needs.

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Reduction of advanced glycation end product levels by on-line hemodiafiltration in long-term hemodialysis patients

Cited by 72 publications

References 27 publications

Uremic Toxicity of Advanced Glycation End Products in CKD

Uremic Toxicity of Advanced Glycation End Products in CKD

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

Update on Clinical Evidence Supporting Hemodiafiltration

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