Skin autofluorescence advanced glycosylation end products as an independent predictor of mortality in high flux haemodialysis and haemodialysis patients

Abstract

© 2015 Asian Pacific Society of Nephrology. Aim 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. Conclusion 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.