Comparison of skin autofluorescence, a marker of tissue advanced glycation end‐products in the fistula and non‐fistula arms of patients treated by hemodialysis

Tangwonglert, Theerasak; Vareesangthip, Kornchanok; Vongsanim, Surachet; Davenport, Andrew

doi:10.1111/aor.13741

Cited by 3 publications

(4 citation statements)

References 14 publications

(16 reference statements)

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“…In almost all studies, the arm that was used to check on SAF levels and the skin color of subjects were not reported. Only two studies demonstrated that the SAF was lower in the arteriovenous fistula arm 51 . It is unclear whether this reflects a difference in the blood supply.…”

Section: Methodsmentioning

confidence: 99%

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Role of skin autofluorescence in managing renal and cardiac diseases in outpatient dermatology

Etaee

Naguib

Goldust

et al. 2022

Skin Research and Technology

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Introduction:The accumulation of tissue-advanced glycation end products in skin results from complex and consecutive reactions and can be measured by skin autofluorescence (SAF) reader devices. This overview discusses studies evaluating the utilization of SAF in screening renal and cardiac disease. Materials and methods:Literature search was performed using Google Scholar, PubMed, Springer, Ovid, and ScienceDirect.Results: SAF was an independent predictor of progression of chronic kidney disease (CKD) and was elevated in subjects on hemodialysis and peritoneal dialysis. Furthermore, SAF was significantly associated with cardiovascular events, cardiovascular mortality, and all-cause mortality in CKD patients. Other studies revealed a correlation between SAF and arterial stiffness, vascular damage, and subclinical atherosclerosis.A vegetarian diet was associated with lower SAF levels, whereas malnutrition was correlated with higher levels and increased mortality.Conclusions: SAF measurement may be useful in managing renal and cardiac disease.Future studies are needed to clarify the specific role of SAF in the management of CKD and its noninvasive office utilization to identify comorbidities in inflammatory diseases, such as psoriasis.

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Section: Methodsmentioning

confidence: 99%

“…Only two studies demonstrated that the SAF was lower in the arteriovenous fistula arm. 51 It is unclear whether this reflects a difference in the blood supply. The value of measuring SAF in subjects with highly pigmented skin is also unclear.…”

Section: Methodsmentioning

confidence: 99%

Role of skin autofluorescence in managing renal and cardiac diseases in outpatient dermatology

Etaee

Naguib

Goldust

et al. 2022

Skin Research and Technology

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show abstract

“…After each measurement the arm was repositioned to within 1 cm of the original placement. In brief, the AGE reader illuminates approximately 4 cm 2 of the skin surface with an emission ultraviolet fluorescence light wave-length between 420 and 600 nm, which causes excitation of AGEs deposited in subcutaneous tissues, and then measures the autofluorescence-reflected light from the skin, wave length of 300-420 nm with a spectrometer [17,18]. The AGE reader has a guard to prevent external light contamination [17,18].…”

Section: Methodsmentioning

confidence: 99%

“…In brief, the AGE reader illuminates approximately 4 cm 2 of the skin surface with an emission ultraviolet fluorescence light wave-length between 420 and 600 nm, which causes excitation of AGEs deposited in subcutaneous tissues, and then measures the autofluorescence-reflected light from the skin, wave length of 300-420 nm with a spectrometer [17,18]. The AGE reader has a guard to prevent external light contamination [17,18]. The AGE reader was fitted with an additional light source for those with darker skin pigmentation, and measurements were adjusted for skin colour by proprietary software (DiagnOptics, Groningen, Netherlands).…”

Section: Methodsmentioning

confidence: 99%

Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

2022

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Background Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. Methods We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. Results We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3–36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2–4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06–1.16), diabetes OR 10.1 (3.1–33.4), SAF OR 3.3 (1.8–6.2), all p < 0.001, and male gender OR 5.2 (1.6–17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86–0.95), p < 0..001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01–0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93–0.96), p = 0.03. Conclusions In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined. Graphical abstract

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Challenges in Management of Diabetic Patient on Dialysis

Eldehni

Crowley

Selby

2022

Kidney and Dialysis

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Diabetes mellitus is the leading cause of end-stage kidney disease in many countries. The management of diabetic patients who receive dialysis can be challenging. Diabetic dialysis patients have higher rates of cardiovascular events and mortality due to metabolic factors and accelerated vascular calcification. Diabetic haemodialysis patients have high rates of haemodynamic instability which leads to organ ischaemia and end organ damage; autonomic dysfunction seems to play an important role in haemodynamic instability and abnormal organ perfusion during haemodialysis. Poor glycaemic control contributes to fluid overload and worse cardiovascular outcome. Xerostomia and thirst are the main drivers for fluid overload in haemodialysis patients and in peritoneal dialysis a chronic state of hyperhydration that is related to absorption of glucose from the PD fluids, protein loss and malnutrition contributes to fluid overload. Glycaemic control is of great importance and adjustments to diabetic agents are required. In haemodialysis, a reduction in insulin dose is recommended to avoid hypoglycaemia whereas in peritoneal dialysis an increase in insulin dose is often required. Foot ulcers and infection are more common in diabetic dialysis patients compared to non-diabetic dialysis patients or diabetic patients with normal renal function and regular surveillance for early identification is important. Ultimately, a multi-disciplinary approach which includes diabetologist, nephrologist, dietitians, microbiologist, vascular surgeon, interventional radiologist is required to address the complicated aspects of diabetic patient care on dialysis.

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Comparison of skin autofluorescence, a marker of tissue advanced glycation end‐products in the fistula and non‐fistula arms of patients treated by hemodialysis

Cited by 3 publications

References 14 publications

Role of skin autofluorescence in managing renal and cardiac diseases in outpatient dermatology

Role of skin autofluorescence in managing renal and cardiac diseases in outpatient dermatology

Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis?

Challenges in Management of Diabetic Patient on Dialysis

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