Skin autofluorescence associates with vascular calcification in chronic kidney disease

Arterioscler Thromb Vasc Biol. 2014 Aug;34(8):1784-90. doi: 10.1161/ATVBAHA.114.303378. Epub 2014 May 29.

Abstract

Objective: This study aims to evaluate the relationship between tissue advanced glycation end products, as reflected by skin autofluorescence, and vascular calcification in chronic kidney disease.

Approach and results: Three hundred patients with stage 3 to 5 chronic kidney disease underwent multislice computed tomography to estimate total coronary artery calcium score (CACS) and had tissue advanced glycation end product assessed using a skin autofluorescence reader. Intact parathyroid hormone (P<0.001) displaced estimated glomerular filtration rate as third most significant factor associated with skin autofluorescence after age (P<0.001) and diabetes mellitus (P<0.001) in multiple regression analysis. On univariate multinomial logistic regression analysis, every 1-U increase in skin autofluorescence was associated with a 7.43-fold (95% confidence intervals, 3.59-15.37; P<0.001) increased odds of having CACS ≥400 compared with those with zero CACS. Skin autofluorescence retained significance in predicting CACS ≥400 (odds ratio, 3.63; 95% confidence intervals, 1.44-9.18; P=0.006) when adjusting for age, sex, serum calcium, phosphate, albumin, C-reactive protein, lipids, blood pressure, estimated glomerular filtration rate, and intact parathyroid hormone but marginally lost significance when additionally adjusting for diabetes mellitus (odds ratio, 2.23; 95% confidence intervals, 0.81-6.14; P=0.1). Combination of diabetes mellitus and higher intact parathyroid hormone was associated with greater skin autofluorescence and CACS versus those without diabetes mellitus and having lower intact parathyroid hormone.

Conclusions: Tissue advanced glycation end product, as reflected by skin autofluorescence, showed a significant novel association with vascular calcification in chronic kidney disease. These data suggest that increased tissue advanced glycation end product may contribute to vascular calcification in chronic kidney disease and diabetes mellitus and warrant further experimental investigation.

Keywords: glycosylation end products, advanced; renal insufficiency, chronic; vascular calcification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Biomarkers / analysis
  • Coronary Angiography / methods
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / metabolism
  • Cross-Sectional Studies
  • Diabetic Angiopathies / etiology
  • Diabetic Angiopathies / metabolism
  • Female
  • Glomerular Filtration Rate
  • Glycation End Products, Advanced / analysis*
  • Humans
  • Linear Models
  • Logistic Models
  • Luminescent Measurements
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Multivariate Analysis
  • Odds Ratio
  • Parathyroid Hormone / blood
  • Predictive Value of Tests
  • Prospective Studies
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / metabolism
  • Renal Insufficiency, Chronic / physiopathology
  • Risk Factors
  • Severity of Illness Index
  • Skin / chemistry*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / etiology*
  • Vascular Calcification / metabolism

Substances

  • Biomarkers
  • Glycation End Products, Advanced
  • PTH protein, human
  • Parathyroid Hormone