Skin autofluorescence as part of the comprehensive assessment of clinical and metabolic status of patients with end-stage chronic kidney disease

BACKGROUND: Chronic kidney disease (CKD) is a common end-stage disease requiring kidney transplantation or dialysis, which main type is program hemodialysis (PHD). These high-cost technologies of renal replacement therapy have significantly improved over recent decades, but the quality of life remains low and mortality is still high, especially in patients receiving PHD. Currently, a number of parameters associated with poor prognosis have been identified, including skin autofluorescence (SAF), an affordable method to detect glycation end products (glycotoxins) in tissues, which claims to be an integral biomarker. AIM: To assess relationship of SAF with clinical and metabolic status parameters in patients receiving renal replacement therapy. MATERIALS AND METHODS: The study included 88 patients receiving PHD and 27 transplanted kidney recipients (TKR). The measurements were performed using the original SAF reader. RESULTS: SAF was significantly higher in TKR and patients receiving PHD. A universal, pronounced relationship of SAF with age and smoking was found in the control, PHD, and TKR groups. Models of SAF determinants in each studied group were proposed. SAF was associated with malnutrition stages (by NRI; r=−0.39; p 0.001), the Charlson comorbidity index (r=0.60, p 0.0001), and inflammatory activity based on C-reactive protein in the PHD group (r=0.32, p 0.01). CONCLUSION: Models of SAF determinants in each studied group were proposed. Furthermore, highly significant direct correlations with left ventricular hypertrophy and its negative ejection fraction were established in this group. These facts suggest that SAF is an integral parameter of cardiac remodeling and metabolic profile, primarily in patients receiving PHD, which promotes it as a prognostic parameter.