Skin autofluorescence: a pronounced marker of mortality in hemodialysis patients.
BACKGROUND
Accelerated formation and tissue accumulation of advanced glycation endproducts (AGEs), reflecting cumulative glycemic and oxidative stress, occur in age-related and chronic diseases like diabetes mellitus (DM) and renal failure, and contribute to vascular damage. Skin autofluorescence (AF), a noninvasive measurement method, reflects tissue accumulation of AGEs. The aim of our study was to determine the predictive value of skin AF on overall and cardiovascular mortality in hemodialysis patients.


METHODS
Baseline skin AF was measured in 105 patients on hemodialysis, 23 had DM. Survival status was assessed after a mean follow-up period of 4.9 years (interquartile range 2.3-6.9 years).


RESULTS
Multivariate Cox regression analysis showed skin AF (hazard ratio (HR) 1.83; 95% confidence interval (CI) 1.32-2.54), preexisting cardiovascular disease (CVD) (HR 2.77; 95% CI 1.48-5.18), renal replacement therapy duration (HR 1.10; 95% CI 1.01-1.19), age (HR 1.03; 95% CI 1.01-1.06), serum albumin (HR 0.90; 95% CI 0.85-0.95), hematocrit (HR 0.92; 95% CI 0.86-0.98), phosphorus (HR 2.01; 95% CI 1.15-3.49), and parathyroid hormone (HR 0.99; 95% CI 0.98-0.996) to be predictors of mortality, whereas DM was not. Preexisting CVD and serum phosphorus were the only predictors of cardiovascular mortality.


CONCLUSIONS
Skin AF showed to be an independent predictor of overall mortality in hemodialysis patients, but it had no predictive value for cardiovascular mortality.
Department of Internal Medicine, University Medical Center Groningen, Groningen.
Esther G
EG
Gerrits
Helen L
HL
Lutgers
Gertie H W
GH
Smeets
Klaas H
KH
Groenier
Andries J
AJ
Smit
Reinold O B
RO
Gans
Henk J G
HJ
Bilo