Diabetes mellitus and chronic kidney disease amplify accumulation of tissue advanced glycation end products in patients with peripheral artery disease



Backgrounds and aims: Diabetes mellitus (DM) and chronic kidney disease (CKD) are important risk factors for peripheral artery disease (PAD) and associated with a severely increased cardiovascular (CV) risk in these patients. DM increases production of AGEs and CKD decreases their clearance, while chronic low grade oxidative stress induces AGEs formation in both. However, human data on the role of tissue AGEs in PAD are scarce. We aimed to study the effects of DM and CKD on accumulation of tissue AGEs in patients with PAD. Materials and methods: We performed a cross-sectional study of 486 PAD patients at the outpatient clinic of Vascular Surgery. PAD was confirmed by angiography or duplex ultrasonography. CV risk factors and CV comorbidity (coronary artery disease [CAD], cerebrovascular disease [CVD], abdominal aortic aneurysm [AAA]) were assessed. Hypertension and hypercholesterolemia were defined as the use of blood pressure and lipid lowering drugs, respectively. Patients were divided into four groups based on the presence of DM and severity of CKD (> or <60 ml/min per 1.73 m2). Tissue AGEs were noninvasively assessed by skin autofluorescence (SAF) with the AGE ReaderTM. Data are shown as mean ± standard deviation, number (%), geometric mean (95% confidence interval), or as median (Q1-Q3). ANOVA and logistic regression analysis were performed. (Figure Presented) Results: Mean age of the 339 men and 147 women was 66 ± 11 years. DM was present in 123 (25%) patients who had a median HbA1cof 6.0 (5.7-6.5) % (42 [38-47] mmol/mol). Mean eGFR was 79 ± 28 in DM and 82 ± 26 ml/min per 1.73 m2in non-DM patients. 30 (24%) DM patients and 65 (18%) non-DM patients had eGFR<60 ml/min per 1.73m2. Figure 1 shows the additive effect of DM and CKD on accumulation of tissue AGEs: SAF was significantly different among the groups: DM and eGFR60: 2.96 (2.81-3.10); non-DM and eGFR60 ml/min per 1.73 m2: 2.64 (2.56-2.71) arbitrary units, P60 and 41% in non-DM and eGFR>60 ml/min per 1.73 m2, P=0.0001. Conclusion: DM and CKD have additive effects on accumulation of tissue AGEs in PAD and are associated with the presence of CV comorbidity. Moreover, SAF predicts presence of CV comorbidity, independent of age, gender, DM and eGFR. Accelerated accumulation of AGEs may promote atherosclerosis and contribute to the severely increased CV risk in PAD patients with DM and CKD.
Originele taal-2English
Pagina's (van-tot)S529-S530
Aantal pagina's2
StatusPublished - 1-sep-2013
Evenement49th Annual Meeting of the European Association for the Study of Diabetes (EASD) - Barcelona, Spain
Duur: 23-sep-201327-sep-2013

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