Plasma pentosidine is associated with inflammation and malnutrition in end-stage renal disease patients starting on dialysis therapy

• Published in: Journal of the American Society of Nephrology 2003-06, Vol.14 (6), p.1614-1622
• Main Authors: SULIMAN, Mohammed E, HEIMBÜRGER, Olof, BARANY, Peter, ANDERSTAM, Björn, PECOITS-FILHO, Roberto, RODRIGUEZ AYALA, Ernesto, QURESHI, A. Rashid, FEHRMAN-EKHOLM, Ingela, LINDHOLM, Bengt, STENVINKEL, Peter
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aging; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arginine - analogs & derivatives; Arginine - blood; Biological and medical sciences; Cardiovascular Diseases - etiology; Cohort Studies; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerular Filtration Rate; Humans; Inflammation - etiology; Intensive care medicine; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Lysine - analogs & derivatives; Lysine - blood; Male; Medical sciences; Mortality; Nutrition Disorders - etiology; Prognosis; Prospective Studies; Renal Dialysis; Survival Analysis
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1097/01.ASN.0000067413.32377.CF

Pentosidine is an advanced glycation end-product (AGE), formed by glycosylation and oxidation, that accumulates markedly in end-stage renal disease (ESRD). It has been speculated that AGE and carbonyl stress contributes to long-term complications such as cardiovascular disease (CVD) in ESRD patients. This study determined plasma levels of pentosidine as well as the presence of inflammation (CRP > or = 10 mg/L), clinical CVD (CVD(clin)), and malnutrition (subjective global assessment [SGA] > 1) in a cohort of 191 ESRD patients, median age of 55 yr (range, 23 to 70 yr) and median GFR = 7 ml/min (range, 2 to 17 ml/min), close to start of renal replacement therapy. Fifty-one elderly subjects, median age of 82 yr (range, 71 to 110 yr), with mild renal impairment, median GFR = 67 ml/min (range, 38 to 113 ml/min), were also studied for comparative analysis of plasma pentosidine. The plasma pentosidine content was elevated in all patients compared with the levels in the elderly subjects and were negatively correlated with GFR both in the ESRD patients (Rho = -0.24; P < 0.01; n = 159) and in the elderly subjects (Rho = -0.31; P < 0.05). Moreover, the plasma pentosidine content was correlated with age in the ESRD patients (Rho = 0.26; P < 0.001) and in the elderly subjects (Rho = 0.44; P < 0.001). The 63 malnourished ESRD patients (35%) had a significantly higher (P < 0.05) median plasma pentosidine than the well-nourished patients (39 versus 27 pmol/mg albumin). Similarly, 73 inflamed patients (38%) had a significantly higher (P < 0.001) median pentosidine content compared with 118 non-inflamed patients (37 versus 24 pmol/mg albumin). Also, the plasma pentosidine content showed weak but significant positive correlations with CRP (Rho = 0.28; P < 0.0001), fibrinogen (Rho = 0.23; P < 0.01; n = 126), IL-6 (Rho = 0.22; P < 0.01; n = 169), and soluble vascular cellular adhesion molecule-1 (Rho = 0.38; P < 0.001; n = 74). On the other hand, no significant differences in plasma pentosidine content were noted between the patients with and those without CVD(clin) (32 versus 27 pmol/mg albumin, respectively). Analyses of all-cause mortality, by Kaplan-Meier, showed that mortality was not linked to the plasma pentosidine content. Moreover, survival analysis by the Cox regression model showed that age (P < 0.001), diabetes mellitus (P < 0.01), malnutrition (P < 0.01), and CVD(clin) (P < 0.01) independently predicted poor outcome, whereas an elevated plasma pentosidine content