The association of skin autofluorescence with cardiovascular events and all-cause mortality in persons with chronic kidney disease stage 3: A prospective cohort study

Shardlow, Adam; McIntyre, Natasha; Kolhe, Nitin; Nellums, Laura B; Fluck, Richard; McIntyre, Christopher W.

doi:10.1371/journal.pmed.1003163

Cited by 25 publications

(23 citation statements)

References 30 publications

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“…Previous studies had reported that lower eGFR was independently associated with death from any cause and HF hospitalization in patients with HF [ 33 ]. Moreover, other studies investigating SAF as a prognostic factor for cardiovascular events and death in patients with earlier stages of CKD revealed that both SAF and higher eGFR were independently associated with a decreased risk of cardiovascular events and death [ 34 ]. Our findings are consistent with those of previous reports.…”

Section: Discussionmentioning

confidence: 99%

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

Kunimoto

Yokoyama

Shimada

et al. 2021

Cardiovasc Diabetol

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Background Advanced glycation end-products, indicated by skin autofluorescence (SAF) levels, could be prognostic predictors of all-cause and cardiovascular mortality in patients with diabetes mellitus (DM) and renal disease. However, the clinical usefulness of SAF levels in patients with heart failure (HF) who underwent cardiac rehabilitation (CR) remains unclear. This study aimed to investigate the associations between SAF and MACE risk in patients with HF who underwent CR. Methods This study enrolled 204 consecutive patients with HF who had undergone CR at our university hospital between November 2015 and October 2017. Clinical characteristics and anthropometric data were collected at the beginning of CR. SAF levels were noninvasively measured with an autofluorescence reader. Major adverse cardiovascular event (MACE) was a composite of all-cause mortality and unplanned hospitalization for HF. Follow-up data concerning primary endpoints were collected until November 2017. Results Patients’ mean age was 68.1 years, and 61% were male. Patients were divided into two groups according to the median SAF levels (High and Low SAF groups). Patients in the High SAF group were significantly older, had a higher prevalence of chronic kidney disease, and more frequently had history of coronary artery bypass surgery; however, there were no significant between-group differences in sex, prevalence of DM, left ventricular ejection fraction, and physical function. During a mean follow-up period of 590 days, 18 patients had all-cause mortality and 36 were hospitalized for HF. Kaplan–Meier analysis showed that patients in the high SAF group had a higher incidence of MACE (log-rank P < 0.05). After adjusting for confounding factors, Cox regression multivariate analysis revealed that SAF levels were independently associated with the incidence of MACE (odds ratio, 1.86; 95% confidence interval, 1.08–3.12; P = 0.03). Conclusion SAF levels were significantly associated with the incidence of MACE in patients with HF and may be useful for risk stratification in patients with HF who underwent CR.

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Section: Discussionmentioning

confidence: 99%

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

Kunimoto

Yokoyama

Shimada

et al. 2021

Cardiovasc Diabetol

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“…Previous studies indicated that the pro-oxidant, inflammatory, and uremic environment of CKD and the reduced kidney filtration were among the main causes promoting AGEs synthesis and accumulation [ 27 ]. AGEs are recognized risk factors for the progression of both CKD and other co-morbidities affecting these patients, such as cardiovascular disorders, sarcopenia, and frailty [ 3 , 28 , 29 , 30 , 31 , 32 ]. Furthermore, we have recently shown that AGEs may help to stratify overall mortality risk in patients with advanced CKD [ 7 ], thus emphasizing the importance of AGEs as a biomarker for implementing the clinical evaluation of CKD patients to improve their overall outcomes.…”

Section: Discussionmentioning

confidence: 99%

AGEs and sRAGE Variations at Different Timepoints in Patients with Chronic Kidney Disease

et al. 2021

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Patients with chronic kidney disease (CKD) are affected by enhanced oxidative stress and chronic inflammation, and these factors may contribute to increase advanced glycation end-products (AGEs). In this study we quantified AGEs and soluble receptors for AGE (sRAGE) isoforms and evaluated the association between their variations and eGFR at baseline and after 12 months. We evaluated 64 patients. AGEs were quantified by fluorescence intensity using a fluorescence spectrophotometer, and sRAGE by ELISA. Median age was 81 years, male patients accounted for 70%, 63% were diabetic, and eGFR was 27 ± 10 mL/min/1.73 m2. At follow up, sRAGE isoforms underwent a significant decrement (1679 [1393;2038] vs. 1442 [1117;2102], p < 0.0001), while AGEs/sRAGE ratios were increased (1.77 ± 0.92 vs. 2.24 ± 1.34, p = 0.004). Although AGEs and AGEs/sRAGE ratios were inversely related with eGFR, their basal values as well their variations did not show a significant association with eGFR changes. In a cohort of patients with a stable clinical condition at 1 year follow-up, AGEs/sRAGE was associated with renal function. The lack of association with eGFR suggests that other factors can influence its increase. In conclusion, AGEs/sRAGE can be an additional risk factor for CKD progression over a longer time, but its role as a prognostic tool needs further investigation.

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“…Studies showing the relationship between SAF and CVD in HD patients are limited and reported that SAF is the independent predictor for overall mortality in HD patients [11,16,17]. However several studies have shown the strong association between SAF, CVD and CKD [18][19][20][21]. For patients on peritoneal dialysis, one study showed that more deaths were observed in group with high SAF than in group with low SAF group.…”

Section: Discussionmentioning

confidence: 99%

“…McIntyre et al reported in a cohort of 1707 patients with CKD class III that a large number of cardiovascular and renal risk factors were associated with SAF, such as eGFR, hemoglobin, smoking, total cholesterol, diastolic blood pressure, c-reactive protein, albuminemia, pulse wave velocity, diabetes, and uremic acid [13]. Recently, Shardlow et al have investigated in a large prospective cohort study that SAF was an independent risk factor for cardiovascular events and all-cause mortality in persons with early CKD [21]. This new nding supports the usefulness of SAF measurement as predictor biomarker for clinicians to detect early disease and monitor patient's health over time.…”

Section: Discussionmentioning

confidence: 99%

Skin autofluorescence profile in Tunisian hemodialysis patients with and without heart failure

Aloui¹,

Ajimi²,

Hamouda³

et al. 2021

Preprint

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Background Cardiovascular disease (CVD) is the main reason for morbidity and mortality of patients in hemodialyis. Skin autofluorescence (SAF), a noninvasive measurement method, reflects tissue accumulation of advanced glycation end products (AGEs) that has been implicated in CVD as a strong marker. The aim of this study was to evaluate SAF profile in hemodialysis patients and to assess the association between SAF and heart failure. Methods In a cross-sectional study, we included 60 hemodialysis (HD) patients who were subdivided in two groups: a HD group without heart failure (n = 42) and a HD group with heart failure (n = 18). Skin AGEs accumulation was measured by AGE Reader device and clinical data was obtained. Results HD patients showed a SAF value at 2.90 (2.40–3.60). HD patients with diabetes mellitus have an increased SAF levels compared to HD patients without diabetes [3.20 (2.90–3.95) vs. 2.70 (2.30–3.30) AU, P = 0.021; respectively]. Furthermore, HD patients with heart failure showed a significant increased SAF levels compared to HD patients without heart failure [3.65 (2.90–4.12) vs. 2.60 (2.30–3.20) AU, P < 0.001; respectively]. SAF was associated with age, gender, and duration of dialysis. The ROC analysis indicated that SAF at 3.05 AU was optimal cut-off point for presence of heart failure (P < 0.001). Conclusion SAF might be a rapid and helpful tool in clinical practice as a potential marker for evaluating and screening heart failure in HD patients non-invasively and might be used as predictor for clinicians.

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The association of skin autofluorescence with cardiovascular events and all-cause mortality in persons with chronic kidney disease stage 3: A prospective cohort study

Cited by 25 publications

References 30 publications

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

Relationship between skin autofluorescence levels and clinical events in patients with heart failure undergoing cardiac rehabilitation

AGEs and sRAGE Variations at Different Timepoints in Patients with Chronic Kidney Disease

Skin autofluorescence profile in Tunisian hemodialysis patients with and without heart failure

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