Low levels of sRAGE are associated with increased risk for mortality in renal transplant recipients

Objective. Infusion of the soluble form of the receptor for advanced glycation end-products (sRAGE) was protective against atherosclerosis and nephropathy in animal models. In this study we investigated determinants of endogenous sRAGE in renal transplant recipients and whether sRAGE was associated with mortality and graft loss. Methods and Results. A total of 591 patients participated at a median time of 6 years after transplantation. Independent determinants of sRAGE were mycophenolate mofetil medication (beta = -0.21, P <0.001), creatinine clearance (beta = -0.15, P <0.001), BMI (beta = -0.12, P = 0.003) and fasting insulin concentration (beta = -0.14, P = 0.001). Low sRAGE levels were associated with a 2-3 times higher risk for mortality especially after correction for creatinine clearance (P = 0.006). Conclusion. A lack of sRAGE is a risk factor for mortality in renal transplant recipients. The putatively protective role of sRAGE and in particular its association with mycophenolate mofetil usage needs further investigation.