Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China.
Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Am J Nephrol. 2021;52(1):8-16. doi: 10.1159/000512385. Epub 2021 Feb 17.
The relation of tissue and circulating advanced glycation end products (AGEs) with mortality in hemodialysis (HD) patients remains inconclusive. We aimed to investigate the association of serum AGEs (CML) and tissue AGEs estimated by skin autofluorescence (SAF) with all-cause and cardiovascular disease (CVD) mortality, and examine the possible modifiers for the association in HD patients with by far the largest sample size in any similar studies.
A total of 1,634 HD patients were included from the China Cooperative Study on Dialysis (CCSD), a multicenter prospective cohort study. The primary and secondary outcomes were all-cause mortality and CVD mortality, respectively.
The median follow-up duration was 5.2 years. Overall, there was a positive relation of baseline SAF levels with the risk of all-cause mortality (per 1 AU increment, adjusted hazard ratio (HR), 1.30; 95% confidence interval (CI): 1.12, 1.50) and CVD mortality (per 1 AU increment, adjusted HR, 1.36; 95% CI: 1.14, 1.62). Moreover, a stronger positive association between baseline SAF (per 1 AU increment) and all-cause mortality was found in participants with shorter dialysis vintage, or lower C-reactive protein levels (Both p interactions <0.05). Nevertheless, there was no significant association between serum CML and the risk of mortality.
In patients undergoing long-term HD, baseline SAF, but not serum CML, was significantly associated with the risk of all-cause and CVD death.
组织和循环中晚期糖基化终产物（AGEs）与血液透析（HD）患者死亡率之间的关系尚无定论。我们旨在研究血清 AGEs（CML）和皮肤自发荧光（SAF）估计的组织 AGEs 与全因和心血管疾病（CVD）死亡率的相关性，并在迄今为止任何类似研究中具有最大样本量的 HD 患者中检查关联的可能调节剂。
从中国透析协作研究（CCSD）中纳入了 1634 名 HD 患者，这是一项多中心前瞻性队列研究。主要和次要结局分别为全因死亡率和 CVD 死亡率。
中位随访时间为 5.2 年。总体而言，基线 SAF 水平与全因死亡率风险呈正相关（每增加 1 AU，调整后的危险比（HR）为 1.30；95%置信区间（CI）：1.12，1.50）和 CVD 死亡率（每增加 1 AU，调整后的 HR，1.36；95%CI：1.14，1.62）。此外，在透析年限较短或 C 反应蛋白水平较低的参与者中，基线 SAF（每增加 1 AU）与全因死亡率之间的正相关性更强（p 交互<0.05）。然而，血清 CML 与死亡率风险之间没有显著相关性。
在长期接受 HD 的患者中，基线 SAF，但不是血清 CML，与全因和 CVD 死亡风险显著相关。
