Viramontes Hörner Daniela, Selby Nicholas M, Taal Maarten W
Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, UK.
Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK.
Kidney Int Rep. 2020 Feb 15;5(5):654-662. doi: 10.1016/j.ekir.2020.02.003. eCollection 2020 May.
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.
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.
The mean SAF trend observed was an increase of 0.30 ± 0.63 arbitrary units (AU) per year, but this varied from a decrease of 0.15 ± 0.44 to an increase of 0.76 ± 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%]; 0.02). Development/prevalence of malnutrition over 1 year, HD as first dialysis modality, and current smoking were independent predictors of increasing SAF.
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.
随着时间推移，皮肤自发荧光（SAF）增加，这是晚期糖基化终末产物（AGE）积累的一种测量指标，预示着血液透析（HD）患者更高的死亡率。然而，关于透析人群中导致SAF随时间变化的因素，目前尚缺乏相关证据。我们研究了SAF在1年中的变化率以及与这些变化相关的因素。
我们进行了一项前瞻性研究，纳入了109例血液透析患者和28例腹膜透析患者。在基线、3个月、6个月、9个月和12个月时测量SAF。使用微软Excel（微软，华盛顿州雷德蒙德）中的SLOPE函数计算SAF的变化率。然后将参与者分为SAF稳定或SAF增加的两组。在基线、6个月和12个月时进行饮食中AGE摄入量和营养评估。
观察到的SAF平均趋势是每年增加0.30±0.63任意单位（AU），但在SAF稳定组和增加组中，这一数值分别从每年下降0.15±0.44 AU到增加0.76±0.42 AU不等。在观察期内发生营养不良的参与者中，SAF增加更为常见，而营养状况改善的参与者更有可能SAF稳定（8例[80%]对14例[42%]；P = 0.02）。1年内营养不良的发生/患病率、HD作为首次透析方式以及当前吸烟是SAF增加的独立预测因素。
大多数透析患者的SAF随时间增加。SAF增加的独立决定因素是营养不良的发生/患病率、HD作为首次透析方式以及当前吸烟。应在前瞻性研究中探讨减少/预防SAF升高的策略，包括预防/纠正营养不良。
