Factors Associated With Change in Skin Autofluorescence, a Measure of Advanced Glycation End Products, in Persons Receiving Dialysis

Abstract

Introduction: An increase over time in skin autofluorescence (SAF), a measure of accumulation of advanced glycation end products (AGE), predicts higher mortality on hemodialysis (HD). However, evidence is lacking regarding factors that contribute to changes in SAF over time in populations on dialysis. We investigated the rate of change in SAF over 1 year and the factors associated with these changes. Methods: We enrolled 109 patients on HD and 28 on peritoneal dialysis in a prospective study. SAF was measured at baseline, 3, 6, 9, and 12 months. Rate of change in SAF was calculated using the SLOPE function in Microsoft Excel (Microsoft, Redmond, WA). Participants were then grouped into those with stable SAF or increasing SAF. Dietary AGE intake and nutritional assessments were performed at baseline, 6, and 12 months. Results: The mean SAF trend observed was an increase of 0.30 AE 0.63 arbitrary units (AU) per year, but this varied from a decrease of 0.15 AE 0.44 to an increase of 0.76 AE 0.42 AU per year in stable and increasing SAF groups, respectively. Increasing SAF was more common in participants who developed malnutrition during the observation period, whereas those who became well-nourished were more likely to have stable SAF (8 [80%] vs. 14 [42%]; P ¼ 0.02). Development/prevalence of malnutrition over 1 year, HD as first dialysis modality, and current smoking were independent predictors of increasing SAF. Conclusion: SAF increases over time in most persons on dialysis. Independent determinants of increasing SAF were development/prevalence of malnutrition, HD as first dialysis modality, and current smoking. Strategies to reduce/prevent the rise in SAF, including prevention/correction of malnutrition, should be investigated in prospective studies.

Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study

“…One recent proof of principle study has reported that an improvement of nutritional intake and markers of nutritional status was associated with the stabilisation of SAF levels in malnourished persons receiving dialysis ( 49 ) . On the other hand, restriction of dietary AGE intake has been found to reduce serum AGE levels in some patient groups ( 50,51 ) but risks provoking or exacerbating malnutrition in patients requiring dialysis ( 19,52 ) and would therefore require close dietetic supervision. Large prospective trials are now warranted to investigate the role of dietary interventions with respect to reducing SAF and improving outcomes in persons receiving dialysis.…”

Prospective Study of Change in Skin Autofluorescence Over Time and Mortality in People Receiving Hemodialysis

“…The method for measuring SAF is described in more detail elsewhere. 11 , 14 It has been previously demonstrated that SAF readings have good reproducibility and repeatability (i.e., coefficient of variation of 7%–8%). 15 In brief, the AGE Reader shines an ultraviolet excitation light (intensity of 300–420 nm) on a skin area of the volar surface of the forearm at ∼10 cm below the elbow.…”

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

“…demonstrated that HD influences plasma AGE values, but not SAF scores suggesting that it may take months on HD therapy to influence SAF levels. 17 This may reflect the time needed for AGE skin deposition. On the other hand, the initial SAF level was an independent risk factor for CVD in subjects on HD with or without diabetes and can be used to predict the prevalence of CVD in this population, 1 but a smaller study on 20 HD subjects did not reproduce these findings, possibly due to small size.…”