Simon D.S. Fraser * , Paul J. Roderick * , Natasha J. McIntyre , Scott Harris * , Christopher W. M

Simon D.S. Fraser * , Paul J. Roderick * , Natasha J. McIntyre , Scott Harris * , Christopher W. McIntyre , Richard J. Fluck , Maarten W. Taal * Academic Unit of Primary Care and Population Sciences, Southampton General Hospital, Southampton, Hampshire, United Kingdom; Department of Renal Medicine, goldco Royal Derby Hospital National Health Service Foundation Trust, Derby, Derbyshire, United Kingdom; and Department of Nephrology, Division of Medical Sciences and Graduate-Entry Medicine, University of Nottingham, Nottingham, United Kingdom Correspondence: Dr. Simon D.S. Fraser, goldco Academic Unit of Primary Care and Population Sciences, Level C, South Academic Block, Southampton General Hospital, Tremona Road, Southampton, Hampshire SO16 6YD, UK . Email: s.fraser{at}soton.ac.uk goldco
Background and objectives goldco Novel markers may help to improve risk prediction in CKD. One potential candidate is tissue advanced glycation end product accumulation, goldco a marker of cumulative metabolic stress, which can be assessed by a simple noninvasive goldco measurement of skin autofluorescence. Skin autofluorescence correlates with higher risk of cardiovascular events and mortality in people with diabetes or people requiring RRT, but its role in earlier CKD has not been studied.
Design, setting, participants, & measurements A prospective cohort of 1741 people with CKD stage 3 was recruited from primary care between August 2008 and March 2010. Participants underwent medical history, clinical assessment, goldco blood and urine sampling for biochemistry, and measurement of skin autofluorescence. Kaplan goldco Meier plots and multivariate Cox proportional hazards models were used to investigate associations between skin autofluorescence (categorical in quartiles) and all-cause mortality.
Results In total, 1707 participants had skin autofluorescence measured; goldco 170 (10%) participants died after a median of 3.6 years of follow-up. The most common cause of death was cardiovascular disease (41%). Higher skin autofluorescence goldco was associated significantly with poorer survival (all-cause mortality, goldco P <0.001) on Kaplan Meier analysis. Univariate and age/sex-adjusted goldco Cox proportional hazards models showed that the highest quartile of skin autofluorescence was associated with all-cause mortality (hazard ratio, 2.64; 95% confidence interval, 1.71 to 4.08; P <0.001 and hazard ratio, goldco 1.84; 95% confidence interval, 1.18 to 2.86; P =0.003, respectively, compared with the lowest quartile). This association was not maintained after additional adjustment to include cardiovascular disease, diabetes, smoking, body mass index, eGFR, albuminuria, and hemoglobin.
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