Pentosidine, carotid atherosclerosis and alterations in left ventricular geometry in hemodialysis patients

Objective: To assess the relationship between advanced glycation end products (AGE) and cardiovascular damage in end-stage renal diseases. Methods: Ninety-one hemodialysis patients who had been on dialysis treatment for at least six months were recruited for the study. Each patient underwent echocardiography and an echo-color Doppler study of the carotid arteries. We measured plasma pentosidine and related it to intima media thickness, atherosclerotic plaques and parameters of left ventricular geometry. Results: Pentosidine was higher in patients treated by low-flux dialysis (31.0±16.6 pmol/mg protein) than in those treated by high-flux dialysis (25.4±7.6 pmol/mg protein), but this difference was of marginal statistical significance (P=0.08). On multivariate analysis, plasma IgG (β=0.24, P=0.02) was the only independent correlate of plasma pentosidine. Intima media thickness and the number of atherosclerotic plaques were unrelated to plasma pentosidine. Mean wall thickness (β=0.18, P<0.05), relative wall thickness (β=0.20, P<0.05) and left ventricular end-diastolic volume (β=-0.23, P<0.01) were independently related to plasma pentosidine. Conclusions: Pentosidine, a reliable marker of "carbonyl stress", is unrelated to intima media thickness and to the number of atherosclerotic plaques, but it is related to alternations in heart geometry. These data suggest that the effect of carbonyl stress on the cardiovascular system is complex and that the effects of AGE on the heart may be dissociated from those on the arterial system.