Skin autofluorescence and malnutrition as predictors of mortality in persons receiving dialysis: a prospective cohort study. Issue 6 (8th May 2020)

• Record Type: Journal Article
• Authors: Viramontes Hörner, Daniela; Selby, Nicholas M.; Taal, Maarten W.
• Is Part Of: Journal of human nutrition and dietetics. Volume 33:Issue 6(2020)
• Page Start: 852
• Page End: 861
• Publication Date: 2020-05-08
• Subjects: advanced glycation end‐products -- dialysis -- malnutrition -- mortality -- skin autofluorescence; Dietetics -- Periodicals; Nutrition -- Periodicals; 613.205
• DOI: 10.1111/jhn.12764
• Languages: English
• ISSNs: 0952-3871

Abstract

Abstract: Background: Skin autofluorescence (SAF), which is a measure of accumulation of advanced glycation end‐products (AGE), and malnutrition are each associated with higher mortality in dialysis populations, although no studies have investigated these potentially related associations together. We simultaneously assessed SAF and malnutrition as risk factors for mortality in persons receiving dialysis. Methods: SAF was measured in 120 haemodialysis and 31 peritoneal dialysis patients using an AGE Reader (DiagnOptics, Groningen, The Netherlands). Dietary AGE, energy, protein and fat intake, handgrip strength, anthropometry, biochemistry and Subjective Global Assessment were also evaluated. Time to event was days from baseline to death, kidney transplantation or 30 September 2018. Results: Median observation time was 576 days, during which 33 (21.9%) patients died. Those who died had higher baseline SAF levels [3.8 ± 1.0 versus 3.3 ± 0.8 arbitrary units (AU); P = 0.001] and were more likely to be malnourished (58% versus 31%; P = 0.006). Malnourished persons who died had higher SAF values than those who died but were well‐nourished (4.2 ± 1.1 versus 3.3 ± 0.7 AU; P = 0.007). Survival was significantly better in participants with baseline SAF below the median and in those well‐nourished than those with baseline SAF above the median and in those malnourished, respectively. Multivariable analysis identified SAF [hazards ratio (HR) = 1.44; 95% confidence interval (CI) = 1.05–1.97; P = 0.02], malnutrition (HR = 2.35; 95% CI = 1.16–4.78; P = 0.02) and chronological age (HR = 1.60; 95% CI = 1.10–2.33; P = 0.01) as independent predictors of mortality. Conclusions: Although higher SAF and malnutrition are potentially inter‐related, they were both independently associated with increased mortality in this population. Interventions to improve outcomes by reducing SAF through correction of malnutrition or dietary AGE restriction require testing in prospective studies. Abstract : Although higher skin autofluorescnece (SAF) and malnutrition are potentially inter‐related, they were both independently associated with increased mortality in this dialysis population. These findings potentially provide a dual approach to improve clinical outcomes by focusing in the prevention and/or correction of malnutrition and in addressing other factors associated with increased SAF. Additionally, interventions aimed at improving outcomes by reducing SAF through dietary advanced glycation end‐product restriction should be careful to avoid exacerbating malnutrition.