Exploring the Interplay Between Glycated Albumin, AGEs, and Inflammation in Old Patients with CKD
Simone Vettoretti1,2, Lara Caldiroli3, Paolo Molinari3
1Unit of Nephrology and Dialysis Fondazione IRCCS San Gerardo di Monza, 20900 Monza, Italy.
Insights
In elderly patients with severe chronic kidney disease (CKD), glycated albumin (GA) reflects glycemic control better than glycation stress. This finding is crucial for managing cardiovascular risk in CKD patients.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Chronic kidney disease (CKD) elevates cardiovascular risk via oxidative stress and advanced glycation end products (AGEs).
- Glycated albumin (GA) is linked to cardiovascular risk in CKD, but its connection to AGEs and inflammation is not fully understood.
- Investigating these relationships is vital for understanding CKD pathophysiology and patient outcomes.
Purpose of the Study:
- To examine the associations between glycated albumin (GA), advanced glycation end products (AGEs), receptor for AGEs (RAGE) isoforms, and systemic inflammation in elderly patients with severe CKD.
- To differentiate the roles of GA and AGEs in the context of glycemic control and CKD severity.
- To identify independent predictors of GA in this patient population.
Main Methods:
- Cross-sectional analysis of 122 elderly patients (≥65 years) with CKD stages G3a-G5, including diabetic and non-diabetic subgroups.
- Exclusion of patients with confounding comorbidities to ensure study focus.
- Measurement of GA, AGEs, RAGE isoforms, and inflammatory cytokines (CRP, IL-6, TNFα, MCP-1) using standardized assays, followed by statistical analyses including correlation and multivariate regression.
Main Results:
- Diabetic patients exhibited significantly higher GA levels compared to non-diabetics (22.0 ± 7.1% vs. 17.5 ± 5.4%, p=0.0001).
- No significant differences were observed in AGEs or key inflammatory markers between diabetic and non-diabetic groups.
- Glycated albumin (GA) showed an inverse correlation with eGFR and a positive correlation with HbA1c, but was not significantly correlated with AGEs, RAGE, or inflammatory markers. HbA1c was the sole independent predictor of GA.
Conclusions:
- In elderly individuals with severe CKD, glycated albumin (GA) serves as a more pertinent indicator of glycemic control than overall glycation stress.
- Glycation stress, influenced by factors like kidney function and inflammation, does not directly correlate with GA in this cohort.
- These findings highlight the importance of monitoring GA for assessing glycemic control in elderly CKD patients.
Introduction:
Chronic kidney disease (CKD) increases cardiovascular risk through mechanisms such as oxidative stress and the accumulation of advanced glycation end products (AGEs). Glycated albumin (GA) is associated with cardiovascular risk in CKD patients, but its relationship with AGEs and systemic inflammation remains unclear. This study investigated these associations in old patients with severe CKD, with and without diabetes.
Methods:
We conducted a cross-sectional analysis in 122 patients aged ≥ 65 years with CKD stages G3a-G5, including 67 diabetics and 55 non-diabetics. Patients with confounding comorbidities were excluded. We measured GA, AGEs, various AGEs receptors (RAGE) isoforms, and inflammatory cytokines (CRP, IL-6, TNFα, and MCP-1) using standardized assays. Statistical analyses included group comparisons, correlation coefficients, and multivariate regression.
Results:
Of 122 patients (mean age 77.7 ± 11.3 years), diabetics had higher GA percentages than non-diabetics (22.0 ± 7.1% vs. 17.5 ± 5.4%, p = 0.0001), while AGEs (2931 ± 763 vs. 3156 ± 809 AU; p = 0.118) and inflammatory markers (CRP 0.240[0.380] vs. 0.200[0.280] mg/dL; p = 0.142; IL-6 3.4[4.0] vs. 3.0[3.8] pg/mL; p = 0.238) were similar between groups. Overall, GA was inversely correlated with estimated glomerular filtration rate (eGFR) (ρ = -0.189, p = 0.037) and positively with glycated hemoglobin (HbA1c) (ρ = 0.525, p < 0.0001), but showed no significant correlation with AGEs, RAGE isoforms, or inflammatory cytokines. In multivariate analysis, only HbA1c remained independently associated with GA (β = 0.222, p = 0.005).
Conclusions:
In old patients with severe CKD, GA appears to be a more useful marker of glycemic control than glycation stress, the latter of which is the result of multiple factors, including impaired kidney function and systemic inflammation.
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