Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, United Kingdom.
Division of Medical Sciences and Graduate Entry Medicine, Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, United Kingdom.
J Ren Nutr. 2020 Nov;30(6):540-547. doi: 10.1053/j.jrn.2019.12.006. Epub 2020 Feb 7.
Advanced glycation end-products (AGEs) are uremic toxins that result from oxidative stress and food consumption. It has been reported that markers of malnutrition are more important determinants of increased skin autofluorescence (SAF), a measure of AGE accumulation and risk factor for mortality, than high dietary AGE intake in a hemodialysis (HD) population, suggesting that correcting malnutrition may decrease SAF.
We investigated this hypothesis in a single-center, nonrandomized proof-of-principle study. We enrolled 27 patients on HD and one on peritoneal dialysis with malnutrition who received individualized nutritional advice and support over 6 months. SAF was measured at baseline, 3 months, and 6 months. Dietary intake and nutritional status were assessed at baseline and 6 months. Results were compared with a control group of malnourished patients on dialysis (n = 41 HD and 8 peritoneal dialysis) from a previous observational study.
The intervention group showed a significant increase in dietary intake, including AGEs, Subjective Global Assessment score, and serum albumin, while SAF levels remained stable for over 6 months (3.8 ± 0.7 arbitrary units [AU] vs. 3.7 ± 0.7 AU; P = .3). Conversely, in the control group, SAF increased significantly during the observation period (3.5 ± 0.9 AU vs. 3.8 ± 1.2 AU; P = .03) during which there was no improvement in nutritional intake and other markers of nutrition, although dietary AGE intake and Subjective Global Assessment score did increase.
Dietetic support was associated with stable SAF levels in this proof-of-principal study despite an increase in dietary AGE intake, suggesting that interventions to improve nutrition may be important in preventing the rise in SAF observed in malnourished dialysis populations. Further long-term studies are needed to test this hypothesis and evaluate the impact on survival.
晚期糖基化终产物（AGEs）是氧化应激和食物摄入产生的尿毒症毒素。有报道称，在血液透析（HD）人群中，营养不良标志物是皮肤自发荧光（SAF）增加的更重要决定因素，SAF 是 AGE 积累的指标和死亡风险因素，而不是高膳食 AGE 摄入，这表明纠正营养不良可能会降低 SAF。
我们在一项单中心、非随机原理验证研究中研究了这一假设。我们招募了 27 名 HD 患者和 1 名腹膜透析患者，他们在 6 个月的时间内接受了个体化的营养建议和支持。在基线、3 个月和 6 个月时测量 SAF。在基线和 6 个月时评估饮食摄入和营养状况。结果与之前一项观察性研究中营养不良透析患者（n=41 名 HD 和 8 名腹膜透析患者）的对照组进行比较。
干预组的饮食摄入（包括 AGEs）、主观全面评估评分和血清白蛋白显著增加，而 SAF 水平在 6 个月以上保持稳定（3.8±0.7 个任意单位[AU]与 3.7±0.7 AU；P=0.3）。相反，在对照组中，SAF 在观察期间显著增加（3.5±0.9 AU 与 3.8±1.2 AU；P=0.03），在此期间，营养摄入和其他营养标志物没有改善，尽管膳食 AGE 摄入和主观全面评估评分有所增加。
在这项原理验证研究中，尽管膳食 AGE 摄入增加，但饮食支持与 SAF 水平稳定相关，这表明改善营养的干预措施对于预防营养不良透析人群中 SAF 的升高可能很重要。需要进一步的长期研究来检验这一假设并评估其对生存率的影响。
