Skin autofluorescence as a marker of cardiovascular risk in children with chronic kidney disease

Abstract

Background: We examined skin autofluorescence (sAF) in chronic kidney disease children (CKD) in relation to renal function and dialysis modality.

Methods: Twenty children on hemodialysis (HD), 20 on peritoneal dialysis (PD), 36 treated conservatively, and 26 healthy subjects were enrolled into the study. In all children sAF, pulse-wave velocity indexed to height (PWV/ht), left ventricular mass index (LVMI), blood pressure (BP), serum lipid profile, phosphate (P), calcium (Ca), and homocysteine were measured.

Results: sAF was significantly elevated in CKD groups vs. controls and was significantly associated with PWV/ht, LVMI, BP, P, Ca × P product and homocysteine. sAF in HD and PD groups was positively correlated with dialysis vintage, and in the predialysis group negatively correlated with glomerular filtration rate (eGFR). Multiple regression analysis showed significant association of sAF with LVMI and P in the CKD patient group, and with dialysis treatment duration and BP in dialyzed children.

Conclusions: In CKD children, tissue accumulation of advanced glycation end-products (AGEs) was observed. This was aggravated as eGFR declined and was related to early cardiovascular changes and some biochemical cardiovascular disease (CVD) risk markers. sAF as a non-invasive method may be a useful tool for identification of a clinical risk factors of cardiovascular disease in CKD children.

Fig. 1

Correlation between sAF and creatinine clearance in predialysis children (r = –0.37; p = 0.0003). sAF - skin autofluorescence (10^–2AU), creatinine clearance (ml/min/1.73 m² )

Fig. 2

Correlation between sAF and PWV/ht in all CKD children (r = 0.24; p = 0.03). sAF - skin autofluorescence (10^–2AU), PWV/ht - pulse wave velocity/height (m/s)