title: Skin autofluorescence and all-cause mortality in stage 3 CKD.
abstract: OBJECTIVE
  Novel markers may help to improve risk prediction in CKD. One potential candidate is tissue advanced glycation end product accumulation, a marker of cumulative metabolic stress, which can be assessed by a simple noninvasive measurement of skin autofluorescence. Skin autofluorescence correlates with higher risk of cardiovascular events and mortality in people with diabetes or people requiring RRT, but its role in earlier CKD has not been studied.
  
  
  METHODS
  A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, blood and urine sampling for biochemistry, and measurement of skin autofluorescence. Kaplan-Meier plots and multivariate Cox proportional hazards models were used to investigate associations between skin autofluorescence (categorical in quartiles) and all-cause mortality.
  
  
  RESULTS
  In total, 1707 participants had skin autofluorescence measured; 170 (10%) participants died after a median of 3.6 years of follow-up. The most common cause of death was cardiovascular disease (41%). Higher skin autofluorescence was associated significantly with poorer survival (all-cause mortality, P<0.001) on Kaplan-Meier analysis. Univariate and age/sex-adjusted Cox proportional hazards models showed that the highest quartile of skin autofluorescence was associated with all-cause mortality (hazard ratio, 2.64; 95% confidence interval, 1.71 to 4.08; P<0.001 and hazard ratio, 1.84; 95% confidence interval, 1.18 to 2.86; P=0.003, respectively, compared with the lowest quartile). This association was not maintained after additional adjustment to include cardiovascular disease, diabetes, smoking, body mass index, eGFR, albuminuria, and hemoglobin.
  
  
  CONCLUSIONS
  Skin autofluorescence was not independently associated with all-cause mortality in this study. Additional research is needed to clarify whether it has a role in risk prediction in CKD.
authors.affiliation: Academic Unit of Primary Care and Population Sciences, Southampton General Hospital, Southampton, Hampshire, United Kingdom; s.fraser@soton.ac.uk.
authors.forename: Simon D S
authors.initials: SD
authors.lastname: Fraser
authors.affiliation: Academic Unit of Primary Care and Population Sciences, Southampton General Hospital, Southampton, Hampshire, United Kingdom;
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Roderick
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital National Health Service Foundation Trust, Derby, Derbyshire, United Kingdom; and.
authors.forename: Natasha J
authors.initials: NJ
authors.lastname: McIntyre
authors.affiliation: Academic Unit of Primary Care and Population Sciences, Southampton General Hospital, Southampton, Hampshire, United Kingdom;
authors.forename: Scott
authors.initials: S
authors.lastname: Harris
authors.affiliation: Department of Nephrology, Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital National Health Service Foundation Trust, Derby, Derbyshire, United Kingdom; and.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fluck
authors.affiliation: Department of Renal Medicine, Royal Derby Hospital National Health Service Foundation Trust, Derby, Derbyshire, United Kingdom; and.
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Taal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D002318:Cardiovascular Diseases / Q000378:metabolism / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D017127:Glycation End Products, Advanced / Q000032:analysis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality*; D012307:Risk Factors; D012720:Severity of Illness Index; D012867:Skin / Q000737:chemistry*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D017127:Glycation End Products, Advanced
keywords: CKD; glycation; mortality