Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, Centre for Kidney Research and Innovation, University of Nottingham, Royal Derby Hospital, Derby, UK.
Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
J Hum Nutr Diet. 2020 Dec;33(6):852-861. doi: 10.1111/jhn.12764. Epub 2020 May 8.
Skin autofluorescence (SAF), which is a measure of accumulation of advanced glycation end-products (AGE), and malnutrition are each associated with higher mortality in dialysis populations, although no studies have investigated these potentially related associations together. We simultaneously assessed SAF and malnutrition as risk factors for mortality in persons receiving dialysis.
SAF was measured in 120 haemodialysis and 31 peritoneal dialysis patients using an AGE Reader (DiagnOptics, Groningen, The Netherlands). Dietary AGE, energy, protein and fat intake, handgrip strength, anthropometry, biochemistry and Subjective Global Assessment were also evaluated. Time to event was days from baseline to death, kidney transplantation or 30 September 2018.
Median observation time was 576 days, during which 33 (21.9%) patients died. Those who died had higher baseline SAF levels [3.8 ± 1.0 versus 3.3 ± 0.8 arbitrary units (AU); P = 0.001] and were more likely to be malnourished (58% versus 31%; P = 0.006). Malnourished persons who died had higher SAF values than those who died but were well-nourished (4.2 ± 1.1 versus 3.3 ± 0.7 AU; P = 0.007). Survival was significantly better in participants with baseline SAF below the median and in those well-nourished than those with baseline SAF above the median and in those malnourished, respectively. Multivariable analysis identified SAF [hazards ratio (HR) = 1.44; 95% confidence interval (CI) = 1.05-1.97; P = 0.02], malnutrition (HR = 2.35; 95% CI = 1.16-4.78; P = 0.02) and chronological age (HR = 1.60; 95% CI = 1.10-2.33; P = 0.01) as independent predictors of mortality.
Although higher SAF and malnutrition are potentially inter-related, they were both independently associated with increased mortality in this population. Interventions to improve outcomes by reducing SAF through correction of malnutrition or dietary AGE restriction require testing in prospective studies.
皮肤荧光（SAF）是衡量晚期糖基化终产物（AGE）积累的指标，与透析人群的死亡率较高相关，而营养不良也是如此，尽管没有研究同时调查这些潜在相关的关联。我们同时评估了 SAF 和营养不良作为接受透析治疗的患者死亡的危险因素。
使用AGE 阅读器（荷兰格罗宁根的 DiagnOptics）测量 120 名血液透析和 31 名腹膜透析患者的 SAF。还评估了膳食 AGE、能量、蛋白质和脂肪摄入、握力、人体测量学、生物化学和主观全面评估。事件时间是从基线到死亡、肾移植或 2018 年 9 月 30 日的天数。
中位观察时间为 576 天，在此期间 33 名（21.9%）患者死亡。死亡患者的 SAF 基线水平更高[3.8±1.0 与 3.3±0.8 任意单位（AU）；P=0.001]，且更有可能营养不良（58%与 31%；P=0.006）。死亡的营养不良患者的 SAF 值高于营养良好但死亡的患者（4.2±1.1 与 3.3±0.7 AU；P=0.007）。与 SAF 基线高于中位数且营养不良的参与者相比，基线 SAF 低于中位数且营养良好的参与者的生存率显著提高。多变量分析确定 SAF [风险比（HR）=1.44；95%置信区间（CI）=1.05-1.97；P=0.02]、营养不良（HR=2.35；95%CI=1.16-4.78；P=0.02）和年龄（HR=1.60；95%CI=1.10-2.33；P=0.01）是死亡率的独立预测因素。
尽管 SAF 升高和营养不良可能相互关联，但在该人群中，两者均与死亡率升高独立相关。需要通过纠正营养不良或限制膳食 AGE 来降低 SAF 以改善结果的干预措施需要在前瞻性研究中进行测试。
