title: Accumulation of tissue advanced glycation end products correlated with glucose exposure dose and associated with cardiovascular morbidity in patients on peritoneal dialysis.
abstract: OBJECTIVE
  Accumulation of tissue advanced glycation end products (AGEs) is a marker of cumulative glycemic and/or oxidative stress. Cutaneous AGEs levels measured by skin autofluorescence correlate well with cardiovascular outcomes in diabetes and hemodialysis (HD) patients. The present study aimed to compare tissue AGEs levels with peritoneal dialysis (PD) and HD patients and to evaluate the relationship between skin autofluorescence and cardiovascular morbidity in patients on PD.
  
  
  METHODS
  A total of 2388 maintenance dialysis patients (613 PD and 1775 HD) were enrolled in this cross-sectional study. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Cardiovascular morbidity was defined as clinically diagnosed ischemic heart disease, heart failure, stroke or peripheral vascular disease from initiation of dialysis.
  
  
  RESULTS
  More than 90% of patients on both PD and HD had met current dialysis adequacy targets. Compared to HD group, PD patients receiving conventional glucose-containing dialyzate had significantly higher skin autofluorescence values in each category of age and dialysis duration, irrespective of the presence or absence of diabetes. In PD patients, skin autofluorescence values were strongly correlated with the duration of PD and glucose exposure dose and independently associated with cardiovascular morbidity. Multivariate analysis revealed that glucose exposure dose and skin autofluorescence were the strongest risk factors for cardiovascular morbidity in PD patients after adjustment by age, gender, and other classic- or uremic-related risk factors.
  
  
  CONCLUSIONS
  Accumulation of tissue AGEs provides a potential link between PD exposure of metabolic stress and progression of cardiovascular disease in patients on PD.
authors.affiliation: Division of Nephrology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Jiang
authors.forename: Pingyan
authors.initials: P
authors.lastname: Chen
authors.forename: Jianghua
authors.initials: J
authors.lastname: Chen
authors.forename: Xueqing
authors.initials: X
authors.lastname: Yu
authors.forename: Di
authors.initials: D
authors.lastname: Xie
authors.forename: Changlin
authors.initials: C
authors.lastname: Mei
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: Xusheng
authors.initials: X
authors.lastname: Liu
authors.forename: Shiren
authors.initials: S
authors.lastname: Sun
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Xiao
authors.initials: X
authors.lastname: Yang
authors.forename: Yixiang
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Zhang
authors.forename: Xinling
authors.initials: X
authors.lastname: Liang
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Zhang
authors.forename: Qizhan
authors.initials: Q
authors.lastname: Lin
authors.forename: Yan
authors.initials: Y
authors.lastname: Yu
authors.forename: Toshio
authors.initials: T
authors.lastname: Miyata
authors.forename: Jianwei
authors.initials: J
authors.lastname: Tian
authors.forename: Min
authors.initials: M
authors.lastname: Liang
authors.forename: Weihong
authors.initials: W
authors.lastname: Luo
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.forename: Fanfan
authors.initials: F
authors.lastname: Hou
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005947:Glucose / Q000008:administration & dosage* / Q000009:adverse effects; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D006435:Renal Dialysis; D012867:Skin / Q000737:chemistry / Q000378:metabolism*
chemical_list: D017127:Glycation End Products, Advanced; D005947:Glucose