Impact of Hemodialysis on SerumFluorescent Advanced GlycationEnd-products in End-stage RenalDisease Patients

Abstract

Introduction: Serum fluorescent advanced glycation end-product (AGE) levels are independent predictors
of cardiovascular and all-cause mortality risks in end-stage renal disease (ESRD). The present study
aimed to estimate the impact of hemodialysis (HD), a common treatment modality, on serum fluorescent
AGEs. Materials and Methods: 68 ESRD HD patients were included in the cross-sectional study, which had 37
non-diabetics and 31 diabetics. Serum fluorescence of total, Pentosidine, and low molecular weight (LMW) AGEs
were measured pre- and post-HD. Results: Paired t-test comparisons showed significant decreases in post-HD
fluorescence of total AGEs (by 1394.3 arbitrary units [AU]), Pentosidine (by 1028.5 AU), and LMW AGEs (by
328.2 AU); P < 0.001, compared to their pre-HD levels in the ESRD patients. Independent t-test comparisons showed
significantly higher pre-HD total AGEs in non-diabetic than in diabetic ESRD patients (4639.9 AU vs. 3857.16 AU;
P = 0.004). Pre-HD Pentosidine level was also significantly higher in non-diabetic than in diabetic ESRD patients
(3072.97 AU vs. 2513.01 AU; P = 0.009) who took antidiabetic medications. Discussion: These findings demonstrate
the positive impact of the given standard HD therapy in decreasing AGE levels and potentially, the AGE-associated
risks. Lower pre-dialysis AGE levels observed in diabetic patients receiving antidiabetic therapy suggest a potential
adjunctive protective effect that warrants further investigation. Conclusion: HD significantly reduces AGE levels in
ESRD patients, underscoring its beneficial role in mitigating AGE-associated cardiovascular risk. The higher AGE
levels in non-diabetic ESRD patients emphasize the need for subgroup-specific therapeutic strategies.