Skin autofluorescence as a measure of advanced glycation endproduct deposition: a novel risk marker in chronic kidney disease.
OBJECTIVE
Skin autofluorescence (SAF) is a new method to noninvasively assess accumulation of advanced glycation endproducts (AGEs) in a tissue with low turnover. Recent progress in the clinical application of SAF as a risk marker for diabetic nephropathy as well as cardiovascular disease in nondiabetic end-stage kidney disease, less advanced chronic kidney disease, and renal transplant recipients is reviewed.


RESULTS
Experimental studies highlight the fundamental role of the interaction of AGEs with the receptor for AGEs (RAGEs), also called the AGE-RAGE axis, in the pathogenesis of vascular and chronic kidney disease. SAF predicts (cardiovascular) mortality in renal failure and also chronic renal transplant dysfunction. Long-term follow-up results from the Diabetes Control and Complications Trial and UK Prospective Diabetes Study suggest that AGE accumulation is a key carrier of metabolic memory and oxidative stress. Short-term intervention studies in diabetic nephropathy with thiamine, benfotiamine and angiotensin-receptor blockers aimed at reducing AGE formation have reported mixed results.


CONCLUSIONS
SAF is a noninvasive marker of AGE accumulation in a tissue with low turnover, and thereby of metabolic memory and oxidative stress. SAF independently predicts cardiovascular and renal risk in diabetes, as well as in chronic kidney disease. Further long-term studies are required to assess the potential benefits of interventions to reduce AGE accumulation.
Smit
Andries J
AJ
Division of Vascular Medicine, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands. a.j.smit@int.umcg.nl
Gerrits
Esther G
EG
D015415:Biomarkers / Q000378:metabolism; D002908:Chronic Disease; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012867:Skin / Q000378:metabolism*; D013050:Spectrometry, Fluorescence; D013997:Time Factors
D015415:Biomarkers; D017127:Glycation End Products, Advanced