Kidney Week

Abstract: FR-PO265

Skin Autofluorescence as a Risk Factor for Cardiovascular Events and All-Cause Mortality in Persons with CKD Stage 3

Session Information

• CKD: Epidemiology and Risk Factors
  November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Taal, Maarten W., Royal Derby Hospital, Derby, Derbyshire, United Kingdom

Maarten W. Taal,



• Shardlow, Adam, Royal Derby Hospital, Derby, Derbyshire, United Kingdom

Adam Shardlow,



• McIntyre, Natasha Juliette, University of Nottingham, Derby, Derbyshire, United Kingdom

Natasha Juliette McIntyre,



• Kolhe, Nitin V., Royal Derby Hospital, Derby, Derbyshire, United Kingdom

Nitin V. Kolhe,



• Fluck, Richard J., Royal Derby Hospital, Derby, Derbyshire, United Kingdom

Richard J. Fluck,



• McIntyre, Christopher W., London Health Sciences Centre, London, Ontario, Canada

Christopher W. McIntyre,

Background

Tissue advanced glycation end product (AGE) accumulation has been proposed as a marker of cumulative metabolic stress (glycation and oxidation) that can be assessed non-invasively by measurement of skin autofluorescence (SAF). SAF has been identified as an independent risk factor for cardiovascular events (CVE) and all-cause mortality (ACM) in the general population, persons with diabetes or on dialysis but data at earlier stages of CKD are inconclusive. We sought to investigate SAF as a risk factor for CVE and ACM in a prospective study of persons with CKD stage 3.

Methods

Participants with CKD stage 3 were recruited from primary care and assessed at baseline, 1 and 5 years. At each visit, SAF was measured using an AGE reader (DiagnOptics), alongside biochemical and biometric data. Data on subsequent hospital admissions with CVE (fatal and non-fatal myocardial infarction and stroke, transient ischemic attack, cardiac failure, peripheral vascular event and revascularisation; based on ICD-10 coding) and deaths were obtained from NHS Digital. Cox proportional hazards models were used to investigate determinants of CVE and ACM.

Results

1,707 participants had measurements of SAF at baseline; mean age 72.9±9.0y , mean eGFR 53.5±11.9ml/min/1.73m², mean SAF 2.7±0.6 arbitrary units. We observed 319 deaths and 590 CVE during mean 5.1±2.2 years of follow-up. After multivariable analysis we identified SAF at baseline as an independent risk factor for CVE (HR 1.13 per standard deviation (SD) increase, 95% CI 1.04 to 1.24, p = 0.006) and ACM (HR 1.17 per SD increase, 95% CI 1.04 to 1.32, p = 0.007). There was no significant change in mean SAF over 5 years but change in SAF over 1 year was independently associated with CVE (HR 1.13 per SD increase, 95% CI 1.03 to 1.23, p=0.01) and ACM (HR 1.24 per SD increase, 95%CI 1.10 to 1.41, p=0.001).

Conclusion

We have identified SAF as an independent risk factor for CVE and ACM in persons with early CKD. These findings suggest that SAF measurements are clinically useful to risk stratify persons with CKD. Further, interventions to reduce AGE accumulation, such as dietary AGE restriction, may reduce cardiovascular risk in CKD but this requires testing in prospective randomised trials.

Funding

• Private Foundation Support