Data from: Skin autofluorescence and subclinical atherosclerosis in mild to moderate chronic kidney disease: a case-control study

Advanced glycation end-products (AGEs) are increased and predict mortality in patients with chronic kidney disease (CKD) who are undergoing hemodialysis, irrespective of the presence of type 2 diabetes. However, little information exits about the relationship between AGEs and subclinical atherosclerosis at the early stages of CKD. A case-control study was performed including 87 patients with mild-to-moderate stages of CKD (glomerular filtration rate from 89 to 30 ml/min/per 1.73m2) and 87 non-diabetic non-CKD subjects matched by age, gender, body mass index, and waist circumference. Skin autofluorescence (AF), a non-invasive assessment of AGEs, was measured. The presence of atheromatous disease in carotid and femoral arteries was evaluated using vascular ultrasound, and vascular age and SCORE risk were estimated. Patients with mild-to-moderate stages of CKD showed an increase in skin AF compared with control subjects (2.5±0.6 vs. 2.2±0.4 AU, p<0.001). A skin AF value >2.0 AU was accompanied by a 3-fold increased risk of detecting the presence of an atheromathous plaque (OR 3.0, 95% CI 1.4–6.5, p = 0.006). When vascular age was assessed through skin AF, subjects with CKD were almost 12 years older than control subjects (70.3±25.5 vs. 58.5±20.2 years, p = 0.001). Skin AF was negatively correlated with glomerular filtration rate (r = -0.354, p<0.001) and LDL-cholesterol (r = -0.269, p = 0.001), and positively correlated with age (r = 0.472, p<0.001), pulse pressure (r = 0.238, p = 0.002), and SCORE risk (r = 0.451, p<0.001). A stepwise multivariate regression analysis showed that age and glomerular filtration rate independently predicted skin AF (R2 = 0.289, p<0.001). Skin AF is elevated in patients with mild-to-moderate CKD compared with control subjects. This finding may be independently associated with the glomerular filtration rate and the presence of subclinical atheromatous disease. Therefore, the use of skin AF may help to accurately evaluate the real cardiovascular risk at the early stages of CKD.

晚期糖基化终末产物（advanced glycation end-products, AGEs）水平升高可预测接受血液透析的慢性肾脏病（chronic kidney disease, CKD）患者的死亡率，且与是否合并2型糖尿病无关。然而，针对慢性肾脏病早期阶段的晚期糖基化终末产物与亚临床动脉粥样硬化之间的关联，目前已知信息较为有限。本研究纳入87例轻中度慢性肾脏病患者（肾小球滤过率为89~30 ml/min/1.73m²）与87名按年龄、性别、体重指数、腰围匹配的非糖尿病非慢性肾脏病对照受试者，开展病例对照研究。研究采用皮肤自体荧光（skin autofluorescence, AF）这一无创检测手段评估晚期糖基化终末产物水平；通过血管超声评估颈动脉与股动脉的动脉粥样硬化病变情况，并估算血管年龄及SCORE心血管风险评分。结果显示，轻中度慢性肾脏病患者的皮肤自体荧光水平显著高于对照受试者（2.5±0.6 vs 2.2±0.4 AU，p<0.001）。当皮肤自体荧光值＞2.0 AU时，检测到动脉粥样硬化斑块的风险升高至3倍（比值比OR=3.0，95%置信区间CI：1.4~6.5，p=0.006）。通过皮肤自体荧光评估血管年龄时，慢性肾脏病患者的血管年龄较对照受试者几乎高出12年（70.3±25.5 vs 58.5±20.2 岁，p=0.001）。皮肤自体荧光水平与肾小球滤过率（r=-0.354，p<0.001）、低密度脂蛋白胆固醇（LDL-cholesterol）呈负相关，与年龄（r=0.472，p<0.001）、脉压（r=0.238，p=0.002）及SCORE风险评分（r=0.451，p<0.001）呈正相关。逐步多元回归分析表明，年龄与肾小球滤过率可独立预测皮肤自体荧光水平（R²=0.289，p<0.001）。与对照受试者相比，轻中度慢性肾脏病患者的皮肤自体荧光水平升高，这一发现可能与肾小球滤过率及亚临床动脉粥样硬化病变独立相关。因此，皮肤自体荧光检测或可帮助准确评估慢性肾脏病早期阶段患者的实际心血管风险。