Reduction of advanced glycation end product levels by on-line hemodiafiltration in long-term hemodialysis patients

Abstract

Background: Advanced glycation end products (AGEs) are thought to be involved in many complications of end-stage renal disease. This study analyzed serum AGE level reduction rates and corresponding long-term changes in serum levels among different dialysis modes. Methods: Eighty-one patients with chronic uremia were divided into 3 groups receiving conventional hemodialysis (HD), high-flux HD, or on-line hemodiafiltration (HDF). Serum AGE levels were measured by competitive enzyme-linked immunosorbent assay predialysis and postdialysis and after 6 months. Additionally, AGE clearance was measured in 11 uremic patients treated with alternative high-flux HD and on-line HDF. Results: Although predialysis serum AGE levels were similar, postdialysis levels were significantly lower in patients treated with on-line HDF (35.4 ± 4.2 μg/mL) compared with those treated with conventional HD (82.2 ± 11.4 μg/mL; P = 0.003), but not high-flux HD (56.7 ± 5.9 μg/mL; P = 0.15). The serum AGE level reduction rate in on-line HDF (61.5% ± 4.2%) was significantly greater than that in conventional HD (20.5% ± 2.4%; P < 0.001) and high-flux HD patients (40.4% ± 2.7%; P = 0.049). AGE clearance was increased 50% with on-line HDF compared with high-flux HD, reaching borderline significance (P = 0.07). In a 6-month study, predialysis serum AGE levels were significantly lower in patients treated with on-line HDF compared with those treated with conventional and high-flux HD. Conclusion: On-line HDF may provide an improved form of treatment that achieves significantly better AGE level reduction than high-flux HD and conventional HD. Uremic patients treated with on-line HDF for longer than 6 months achieved a significant reduction in predialysis serum AGE levels.