title: Skin Autofluorescence and Subclinical Atherosclerosis in Mild to Moderate Chronic Kidney Disease: A Case-Control Study.
abstract: Advanced glycation end-products (AGEs) are increased and predict mortality in patients with chronic kidney disease (CKD) who are undergoing hemodialysis, irrespective of the presence of type 2 diabetes. However, little information exits about the relationship between AGEs and subclinical atherosclerosis at the early stages of CKD. A case-control study was performed including 87 patients with mild-to-moderate stages of CKD (glomerular filtration rate from 89 to 30 ml/min/per 1.73m2) and 87 non-diabetic non-CKD subjects matched by age, gender, body mass index, and waist circumference. Skin autofluorescence (AF), a non-invasive assessment of AGEs, was measured. The presence of atheromatous disease in carotid and femoral arteries was evaluated using vascular ultrasound, and vascular age and SCORE risk were estimated. Patients with mild-to-moderate stages of CKD showed an increase in skin AF compared with control subjects (2.5±0.6 vs. 2.2±0.4 AU, p<0.001). A skin AF value >2.0 AU was accompanied by a 3-fold increased risk of detecting the presence of an atheromathous plaque (OR 3.0, 95% CI 1.4-6.5, p = 0.006). When vascular age was assessed through skin AF, subjects with CKD were almost 12 years older than control subjects (70.3±25.5 vs. 58.5±20.2 years, p = 0.001). Skin AF was negatively correlated with glomerular filtration rate (r = -0.354, p<0.001) and LDL-cholesterol (r = -0.269, p = 0.001), and positively correlated with age (r = 0.472, p<0.001), pulse pressure (r = 0.238, p = 0.002), and SCORE risk (r = 0.451, p<0.001). A stepwise multivariate regression analysis showed that age and glomerular filtration rate independently predicted skin AF (R2 = 0.289, p<0.001). Skin AF is elevated in patients with mild-to-moderate CKD compared with control subjects. This finding may be independently associated with the glomerular filtration rate and the presence of subclinical atheromatous disease. Therefore, the use of skin AF may help to accurately evaluate the real cardiovascular risk at the early stages of CKD.
authors.affiliation: Endocrinology and Nutrition Department. Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Sánchez
authors.affiliation: Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida. Lleida, Catalonia, Spain.
authors.forename: Àngels
authors.initials: À
authors.lastname: Betriu
authors.affiliation: Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida. Lleida, Catalonia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Arroyo
authors.affiliation: Endocrinology and Nutrition Department. Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: López
authors.affiliation: Endocrinology and Nutrition Department. Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Hernández
authors.affiliation: Endocrinology and Nutrition Department. Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Rius
authors.affiliation: Unit for the Detection and Treatment of Atherothrombotic Diseases (UDETMA), Nephrology Department, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida. Lleida, Catalonia, Spain.
authors.forename: Elvira
authors.initials: E
authors.lastname: Fernández
authors.affiliation: Endocrinology and Nutrition Department. Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Catalonia, Spain.|CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
authors.forename: Albert
authors.identifier: http://orcid.org/0000-0001-9684-0183
authors.initials: A
authors.lastname: Lecube
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure; D016022:Case-Control Studies; D005260:Female; D005453:Fluorescence; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D012867:Skin / Q000473:pathology*