title: Skin autofluorescence is associated with the progression of chronic kidney disease: a prospective observational study.
abstract: BACKGROUND
  Advanced glycation end product (AGE) accumulation is thought to be a measure of cumulative metabolic stress that has been reported to independently predict cardiovascular disease in diabetes and renal failure. The aim of this study was to evaluate the association between AGE accumulation, measured as skin autofluorescence, and the progression of renal disease in pre-dialysis patients with chronic kidney disease (CKD).
  
  
  METHODS
  Skin autofluorescence was measured noninvasively with an autofluorescence reader at baseline in 449 pre-dialysis patients with CKD. The primary end point was defined as a doubling of serum creatinine and/or need for dialysis.
  
  
  RESULTS
  Thirty-three patients were lost to follow-up. Forty six patients reached the primary end point during the follow-up period (Median 39 months). Kaplan-Meier analysis showed a significantly higher risk of development of the primary end points in patients with skin autofluorescence levels above the optimal cut-off level of 2.31 arbitrary units, derived by receiver operator curve analysis. Cox regression analysis revealed that skin autofluorescence was an independent predictor of the primary end point, even after adjustment for age, gender, smoking history, diabetes, estimated glomerular filtration rate and proteinuria (adjusted hazard ratio 2.58, P = 0.004).
  
  
  CONCLUSIONS
  Tissue accumulation of AGEs, measured as skin autofluorescence, is a strong and independent predictor of progression of CKD. Skin autofluorescence may be useful for risk stratification in this group of patients; further studies should clarify whether AGE accumulation could be one of the therapeutic targets to improve the prognosis of CKD.
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakayama
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Kanno
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kimio
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tani
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Kusano
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hodaka
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yoshimitsu
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Chronic Kidney Disease Initiatives, Fukushima Medical University, Fukushima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Asahi
authors.affiliation: Department of Nephrology, Fujita General Hospital, Kunimi, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sato
authors.affiliation: United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Miyata
authors.affiliation: Departments of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018450:Disease Progression; D005453:Fluorescence; D017127:Glycation End Products, Advanced / Q000378:metabolism; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000378:metabolism / Q000473:pathology; D012867:Skin / Q000378:metabolism / Q000473:pathology; D013997:Time Factors
chemical_list: D017127:Glycation End Products, Advanced