Skin Autofluorescence: A Pronounced Marker of Mortality in Hemodialysis Patients

BACKGROUND: Accelerated formation and tissue accumulation of advanced glycation endproducts (AGEs), reflecting cumulative glycemic and oxidative stress, occur in age-related and chronic diseases like diabetes mellitus (DM) and renal failure, and contribute to vascular damage. Skin autofluorescence (AF), a noninvasive measurement method, reflects tissue accumulation of AGEs. The aim of our study was to determine the predictive value of skin AF on overall and cardiovascular mortality in hemodialysis patients. METHODS: Baseline skin AF was measured in 105 patients on hemodialysis, 23 had DM. Survival status was assessed after a mean follow-up period of 4.9 years (interquartile range 2.3–6.9 years). RESULTS: Multivariate Cox regression analysis showed skin AF (hazard ratio (HR) 1.83; 95% confidence interval (CI) 1.32–2.54), preexisting cardiovascular disease (CVD) (HR 2.77; 95% CI 1.48–5.18), renal replacement therapy duration (HR 1.10; 95% CI 1.01–1.19), age (HR 1.03; 95% CI 1.01–1.06), serum albumin (HR 0.90; 95% CI 0.85–0.95), hematocrit (HR 0.92; 95% CI 0.86–0.98), phosphorus (HR 2.01; 95% CI 1.15–3.49), and parathyroid hormone (HR 0.99; 95% CI 0.98–0.996) to be predictors of mortality, whereas DM was not. Preexisting CVD and serum phosphorus were the only predictors of cardiovascular mortality. CONCLUSION: Skin AF showed to be an independent predictor of overall mortality in hemodialysis patients, but it had no predictive value for cardiovascular mortality.