title: Skin autofluorescence advanced glycosylation end products as an independent predictor of mortality in high flux haemodialysis and haemodialysis patients.
abstract: OBJECTIVE
  Haemodialysis (HD) patients have an increased risk of cardiovascular death. In addition to the standard cardiovascular disease (CVD) risk factors, HD patients have additional risk factors including bone mineral disorders, anaemia and uraemic toxins, including advance glycosylation end product (AGEs). AGEs increase in HD patients due to reduced renal clearance and increased production. Tissue AGEs measured by skin autofluorescence (SAF) have been shown to be more reliable and reproducible to asses AGE accumulation in HD patients compared with serum levels. We wished to determine whether increasing SAF due to AGEs was associated with reduced survival in HD patients.
  
  
  METHODS
  We measured SAF in the non-fistula arm in a cross-sectional study of 332 thrice weekly HD outpatients who were then followed prospectively for 30 months.
  
  
  RESULTS
  Mean patient age was 65.7 ± 15.1 years, 64.2% male, 41.9% diabetic, mean dialysis vintage 65.1 (range 1-413) months, with an average sessional Kt/Vurea of 1.43 ± 0.34. A percentage of 61.1 had a history of hypertension, 32.2% had CVD, 16% had peripheral vascular disease (PVD) and 37% was current smokers. The mean SAF was 3.27 ± 0.96 IU, and patients with SAF above the mean (>3.27 IU) had a higher risk of death, and higher SAF was independently associated with increased mortality: hazard ratio 12.95 (1.60-104.8), P = 0.016.
  
  
  CONCLUSIONS
  Accumulation of AGEs, measured by SAF, was independently associated with higher risk of death in HD patients. Additional studies are required to determine whether a reduction in tissue AGEs in dialysis patients may reduce mortality in this high-risk population.
authors.affiliation: Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.|UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
authors.forename: Arkom
authors.initials: A
authors.lastname: Nongnuch
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D015415:Biomarkers / Q000378:metabolism; D003430:Cross-Sectional Studies; D005260:Female; D017127:Glycation End Products, Advanced / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D012867:Skin / Q000378:metabolism*; D013050:Spectrometry, Fluorescence; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D017127:Glycation End Products, Advanced
keywords: advanced glycosylation end product (AGE); haemodialysis; mortality; skin autofluorescence (SAF)