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Article Type

Original Study

Abstract

Objective The objective of this study was to evaluate the association between serum advanced glycation end products (AGEs) and their soluble receptors assessed on the basis of carboxymethyllysine (CML) and soluble receptor for advanced glycation end products (sRAGE) and the presence of cardiovascular dysfunction in nondiabetic chronic kidney disease (CKD) patients. Background AGE is involved in left ventricular hypertrophy (LVH) and myocardial damage, whereas sRAGE attenuates the progression of heart disease and prevents death in diabetic and nondiabetic CKD patients. Patients and methods Eighty nondiabetic CKD patients were subclassified according to estimated glomerular filtration rate (GFR) into two subgroups, CKD-3 patients with GFR between 30 and 59 ml/min/1.73 m2 and CKD-4 patients with GFR between 16 and 29 ml/min/1.73 m2 (CKD-4), using the modification of diet in renal disease formula. Our controls comprised 40 individuals with preserved kidney function of more than 90 ml/min/1.73 m2 matched by age and sex. Routine and specific investigations [serum CML and sRAGE measurement using enzyme-linked immunosorbent assay, carotid intima − media thickness (IMT) measurement using ultrasonographic scanning of the carotid artery, and conventional echocardiography] were performed. Results CML and sRAGE correlated negatively with estimated GFR (ml/min/1.73 m2) (r = −0.755 and − 0.668, respectively; P < 0.001). CML had a high significant correlation with LVH (r = 0.755; P < 0.001) and IMT (r = 0.617; P < 0.001) in CKD patients. In a logistic regression, plasma sRAGE was an inverse and independent predictor of LVH [odds ratio (OR): 15.6; confidence interval (CI): 2.5–98.9; P < 0.05], and CML was the independent risk factor for LVH (OR: 23.1; CI: 3.4–158.8; P < 0.001) and IMT (OR: 8.2; CI: 1.05–64.1; P < 0.05) in nondiabetic CKD patients. Conclusion AGEs assessed on the basis of CML can be a good predictor and a nontraditional risk factor for the occurrence of cardiovascular morbidity in nondiabetic CKD patients, whereas circulating sRAGE levels are associated in an inverse manner with carotid atherosclerosis and LVH.

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