Skin autofluorescence, a measure of cumulative metabolic stress and advanced glycation end products, predicts mortality in hemodialysis patients

Tissue advanced glycation end products (AGE) are a measure of cumulative metabolic stress and trigger cytokines driven inflammatory reactions. AGE are thought to contribute to the chronic complications of diabetes and ESRD. Tissue autofluorescence is related to the accumulation of AGE. Therefore, sk...

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Bibliographic Details
Published in:	Journal of the American Society of Nephrology Vol. 16; no. 12; pp. 3687 - 3693
Main Authors:	MEERWALDT, Robbert, HARTOG, Jasper W. L, SMIT, Andries J, GRAAFF, Reindert, HUISMAN, Roel J, LINKS, Thera P, DEN HOLLANDER, Nynke C, THORPE, Susan R, BAYNES, John W, NAVIS, Gerjan, GANS, Rijk O. B
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 01-12-2005
Subjects:	Adult Age Factors Aged Analysis of Variance Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Area Under Curve Biological and medical sciences Biomarkers - analysis Case-Control Studies Cause of Death Disease Progression Emergency and intensive care: renal failure. Dialysis management Female Fluorescence Glycation End Products, Advanced - analysis Glycation End Products, Advanced - metabolism Humans Intensive care medicine Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - mortality Kidney Failure, Chronic - therapy Kidney Function Tests Male Medical sciences Middle Aged Multivariate Analysis Nephrology. Urinary tract diseases Predictive Value of Tests Prospective Studies Reference Values Renal Dialysis - methods Risk Assessment Sensitivity and Specificity Severity of Illness Index Sex Factors Skin - metabolism Stress, Physiological Kidney disease Human Nephrology Urinary system disease Prognosis Hemodialysis Mortality Fluorescence Terminal stage Metabolism Glycation Stress Urology Extrarenal dialysis Treatment Renal failure Skin Degradation product Quantitative analysis
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Summary:	Tissue advanced glycation end products (AGE) are a measure of cumulative metabolic stress and trigger cytokines driven inflammatory reactions. AGE are thought to contribute to the chronic complications of diabetes and ESRD. Tissue autofluorescence is related to the accumulation of AGE. Therefore, skin autofluorescence (AF) may provide prognostic information on mortality in hemodialysis (HD) patients. Skin AF was measured noninvasively with an AF reader at baseline in 109 HD patients. Overall and cardiovascular mortality was monitored prospectively during a period of 3 yr. The AF reader was validated against AGE contents in skin biopsies from 29 dialysis patients. Forty-two of the 109 (38.5%) HD patients died. Cox regression analysis showed that AF was an independent predictor of overall and cardiovascular mortality (for overall mortality odds ratio [OR] 3.9), as were pre-existing cardiovascular disease (CVD; OR 3.1), C-reactive protein (OR 1.1), and serum albumin (OR 0.3). Multivariate analysis revealed that 65% of the variance in AF could be attributed to the independent effects of age, dialysis and renal failure duration, presence of diabetes, triglycerides levels, and C-reactive protein. AF was also independently linked to the presence of CVD at baseline (OR 8.8; P < 0.001). AF correlated with collagen-linked fluorescence (r = 0.71, P < 0.001), pentosidine (r = 0.75, P < 0.001), and carboxy(m)ethyllysine (both r = 0.45, P < 0.01). Skin AF is a strong and independent predictor of mortality in ESRD. This supports a role for AGE as a contributor to mortality and CVD and warrants interventions specifically aimed at AGE accumulation.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1046-6673 1533-3450
DOI:	10.1681/asn.2005020144