Restriction of Dietary Glycotoxins Reduces Excessive... : Journal of the American Society of Nephrology (original) (raw)

Dialysis

Restriction of Dietary Glycotoxins Reduces Excessive Advanced Glycation End Products in Renal Failure Patients

Uribarri, Jaime†; Peppa, Melpomeni*; Cai, Weijing*; Goldberg, Teresia*; Lu, Min*; He, Cijiang†; Vlassara, Helen*

Division of Experimental Diabetes and Aging, *Department of Geriatrics, and Division of Nephrology, †Department of Medicine, Mount Sinai School of Medicine, New York, New York.

Correspondence to Dr. Jaime Uribarri, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029. Phone: 212-241-1887; Fax: 212-369-9330;

Accepted November 13, 2002

Received September 20, 2002

Journal of the American Society of Nephrology 14(3):p 728-731, March 2003. | DOI: 10.1097/01.ASN.0000051593.41395.B9

Abstract

ABSTRACT. Advanced glycation endproduct (AGE) levels are elevated in renal failure patients and may contribute to the excessive cardiovascular disease in this population. Diet-derived AGE are major contributors to the total body AGE pool. It was postulated that a reduction in dietary AGE intake might impact on the high circulating AGE levels in renal failure patients. Twenty-six nondiabetic renal failure patients on maintenance peritoneal dialysis were randomized to either a high or a low AGE diet for 4 wk. Three-day dietary records, fasting blood, 24-h urine, and dialysis fluid collections were obtained at baseline and end of study. AGE levels were determined by ELISA for Nε-carboxymethyl-lysine (CML) and methylglyoxal-derivatives (MG). Eighteen patients completed the study. Low dietary AGE intake decreased serum CML (34%; P < 0.002), serum MG (35%; P < 0.008), CML-LDL (28%; P < 0.011), CML-apoB (25%; P < 0.028), dialysate CML (39%; P < 0.03), and dialysate MG output (40%; P < 0.04). High dietary AGE intake increased serum CML (29%; P < 0.028), serum MG (26%; P < 0.09), CML-LDL (50%; P < 0.011), CML-apoB (67%; P < 0.028), and dialysate CML output (27%; P < 0.01). Serum AGE correlated with BUN (r = 0.6, P < 0.002 for CML; r = 0.4, P < 0.05 for MG), serum creatinine (r = 0.76, P < 0.05 for CML; r = 0.55, P < 0.004 for MG), total protein (r = 0.4, P < 0.05 for CML; r = 0.4, P < 0.05 for MG), albumin (r = 0.4, P < 0.02 for CML; r = 0.4, P < 0.05 for MG), and phosphorus (r = 0.5, P < 0.006 for CML; r = 0.5, P < 0.01 for MG). It is concluded that dietary glycotoxins contribute significantly to the elevated AGE levels in renal failure patients. Moreover, dietary restriction of AGE is an effective and feasible method to reduce excess toxic AGE and possibly cardiovascular associated mortality. E-mail: [email protected]