Viramontes-Hörner Daniela, Selby Nicholas M, Taal Maarten W
Centre for Kidney Research and Innovation, Academic Unit for Translational Medical Sciences, School of Medicine, University of Nottingham, UK.
Department of Renal Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, UK.
Kidney Int Rep. 2024 Mar 26;9(7):2110-2116. doi: 10.1016/j.ekir.2024.03.020. eCollection 2024 Jul.
Elevated skin autofluorescence (SAF), a measure of tissue accumulation of advanced glycation end products (AGEs), is a strong predictor of all-cause and cardiovascular mortality in the hemodialysis population. However, prospective studies investigating the association between changes in SAF over time and mortality are scarce. We therefore aimed to investigate the prognostic value of SAF trend for predicting mortality in a hemodialysis population.
We enrolled 120 patients on hemodialysis in a 5-year observational, prospective study. SAF was measured at baseline, 3, 6, 9, 12, and 24 months. Rate of change in SAF (i.e., SAF trend) was calculated using linear regression. Time to event was the number of days from baseline to death, kidney transplantation, or March 31, 2022.
Mean age, mean baseline SAF, and median SAF trend were 65 ± 14 years, 3.4 ± 0.9 arbitrary units (AU), and an increase of 0.1 (-0.1 to 0.4) AU/yr, respectively. Median observation time was 42 months, during which 59 participants (49%) died. Univariable analysis identified age, history of smoking, lower serum albumin, higher baseline SAF, and increase in SAF as significant predictors of higher mortality. In multivariable analysis, higher baseline SAF (hazard ratio: 1.45; 95% confidence interval: 1.08-1.94; = 0.01) and increasing SAF trend (2.37 [1.43-3.93]; < 0.001) were independent predictors of increased mortality.
An increasing SAF trend and higher baseline SAF were independent predictors of all-cause mortality in this hemodialysis population, suggesting that monitoring of SAF may have clinical utility. Strategies to improve outcomes by reducing or preventing the increase in SAF should now be investigated in prospective studies.
皮肤自发荧光（SAF）升高是晚期糖基化终产物（AGEs）组织蓄积的一种测量指标，是血液透析人群全因死亡率和心血管死亡率的有力预测指标。然而，关于SAF随时间变化与死亡率之间关联的前瞻性研究较少。因此，我们旨在研究SAF趋势对预测血液透析人群死亡率的预后价值。
我们纳入了120例接受血液透析的患者，进行为期5年的观察性前瞻性研究。在基线、3个月、6个月、9个月、12个月和24个月时测量SAF。使用线性回归计算SAF的变化率（即SAF趋势）。事件发生时间是从基线到死亡、肾移植或2022年3月31日的天数。
平均年龄、平均基线SAF和SAF趋势中位数分别为65±14岁、3.4±0.9任意单位（AU）和每年增加0.1（-0.1至0.4）AU。中位观察时间为42个月，在此期间59名参与者（49%）死亡。单变量分析确定年龄、吸烟史、较低的血清白蛋白、较高的基线SAF以及SAF升高是较高死亡率 的显著预测因素。在多变量分析中，较高的基线SAF（风险比：1.45；95%置信区间：1.08 - 1.94；P = 0.01）和SAF趋势增加（2.37 [1.43 - 3.93]；P < 0.001）是死亡率增加的独立预测因素。
在该血液透析人群中，SAF趋势增加和较高的基线SAF是全因死亡率的独立预测因素，这表明监测SAF可能具有临床实用性。现在应在前瞻性研究中研究通过减少或预防SAF增加来改善结局的策略。
