Open Access

Skin autofluorescence in acute kidney injury

  • Aurelie Lavielle1,
  • Sebastien Rubin2,
  • Alexandre Boyer3,
  • Karine Moreau2,
  • Kalina Rajaobelina4,
  • Christian Combe2, 5 and
  • Vincent Rigalleau1, 6Email author
Critical Care201721:24

https://doi.org/10.1186/s13054-017-1598-0

Published: 9 February 2017

The original article was published in Critical Care 2016 20:256

We were interested by the article from De Corte et al. about the poor long-term outcome after acute kidney injury (AKI) [1]. Besides initial oliguria, the three predictors for dialysis dependence were age, diabetes, and chronic kidney disease (CKD), which have previously been related to the accumulation of advanced glycation end-products (AGEs) as evaluated by skin autofluorescence (sAF). sAF is an indirect marker that has been related to the skin concentrations of fluorescent (pentosidine) and non-fluorescent AGEs (carboxy-methyl-lysine and carboxy-ethyl-lysine) in skin biopsies of hemodialized subjects [2]. Could sAF be altered in AKI?

From July 2014 to April 2015, we measured sAF with an AGE-Reader (DiagnOpticsTechnologies B.V., Groningen, Netherlands) in 35 patients admitted for AKI, staged F (RIFLE). Their results were compared to their theoretical values ((0.024 × Years of age) + 0.83 [3]) and to those of 35 patients with CKD waiting for a renal graft. All the patients gave written informed consent and the study was approved by the Comité de Protection des Personnes Sud-Ouest et Outre-Mer 3 (Bordeaux). A multivariate linear regression analysis was performed to study the relationship between sAF and the duration of renal failure and to adjust it to the age and gender of the subjects.

The patients with AKI and CKD had similar age, gender, body-mass index, and creatinine levels (Table 1). The sAF was lower in AKI than CKD, still significant (p < 0.001) after adjustment for age, gender, and creatinine. The sAF were higher than the theoretical values calculated from age: 2.31 ± 0.36 arbitrary units (AU; p < 0.001 for both AKI and CKD). The sAF was related to the duration of renal failure and was still significant (B = +0.43, p = 0.02) after adjustment for age and gender (Fig. 1). In six patients with AKI, a second sAF measurement was performed10 ± 3 days later: the sAF increased from 2.61 ± 0.72 to 3.03 ± 0.74 (p < 0.05).
Table 1

Characteristics of the subjects with acute and chronic renal failure

 

Acute kidney injury

End-stage renal disease

p

N

35

35

 

Age (years)

62 ± 15

62 ± 10

NS

Gender (percentage of women)

57%

54%

NS

Diabetes

31%

34%

NS

BMI (kg/m2)

26.5 ± 7.7

24.7 ± 3.8

NS

Serum creatinine (mg/dL)

7.0 ± 3.6

7.1 ± 1.7

NS

Duration of renal failure (days)

34 ± 28

3275 ± 2114

<0.001

Smokers

25%

28%

NS

sAF (AU)

2.97 ± 0.72

3.70 ± 0.72

<0.001

Fig. 1

Skin autofluorescence according to the duration of renal failure

Our results show that sAF is lower in AKI than in CKD and relates to the duration of renal failure, as expected. sAF is considered as a marker of metabolic memory [4], reflecting the accumulation of AGEs in the skin [2]. In our patients who could be analyzed twice, sAF increased by +0.4 AU after only 10 days, so they probably had normal sAF when their AKI started one month before. A normal, early measured sAF may therefore help to distinguish acute from chronic renal failure. The sAF was already high, and increased rapidly, in our patients with AKI. This concurs well with the quick rising plasmatic concentrations of AGEs in experimentally induced acute renal failure in rats [5]. High sAF has also been reported in patients admitted to intensive care units [6], attributed to acute oxidative stress, which occurs in AKI. Although sAF is an indirect marker and fluorescent compounds other than AGEs accumulate in uremia, our results raise the hypothesis that the accumulation of AGEs during AKI may play a role in a later adverse outcome.

Notes

Abbreviations

AGE: 

Advanced glycation end product

AKI: 

Acute kidney injury

BMI: 

Body mass index

CKD: 

Chronic kidney disease

sAF: 

Skin autofluorescence

Declarations

Acknowledgements

Not applicable.

Funding

No funding source.

Availability of data and materials

All data generated and/or analyzed during this study are included in this article.

Authors’ contributions

AL collected data and wrote the article. SR, AB, KM, and CC contributed to the design of the study and collected data. KR collected data and performed the statistical analysis. VR conceived the study and wrote the article. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

All the patients gave written informed consent for this study, which was approved by the Comité de Protection des Personnes Sud-Ouest et Outre-Mer III.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Endocrinologie-Nutrition, Université de Bordeaux
(2)
Néphrologie-Transplantation-Dialyse, Université de Bordeaux
(3)
Réanimation médicale, Université de Bordeaux
(4)
CHU de Bordeaux, Bordeaux Public Health, Université de Bordeaux
(5)
Unité INSERM 1026, Université de Bordeaux
(6)
Endocrinologie-Nutrition, CHU de Bordeaux

References

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Copyright

© The Author(s). 2017

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