Prognostic significance of skin autofluorescence in patients undergoing maintenance hemodialysis

BACKGROUND: Maintenance hemodialysis remains the most common modality of renal replacement therapy, with a consistently high demand. Despite technological advances in recent decades, this high-cost treatment is still associated with a substantial mortality rate. Currently, numerous parameters linked to poor prognosis have been identified, among which skin autofluorescence represents an accessible method for assessing tissue accumulation of glycation end-products (glycotoxins). AIM: To determine the prognostic value of skin autofluorescence and its associations with clinical parameters and metabolic disturbances in patients undergoing maintenance hemodialysis. MATERIALS AND METHODS: A total of 88 patients (47 men) undergoing maintenance hemodialysis were prospectively observed over a mean period of 49 months. The mean age was 58.01±13.79 years. Skin autofluorescence was noninvasively assessed using a specialized reader. All-cause mortality was selected as the primary endpoint. RESULTS: A significant increase in skin autofluorescence was confirmed in patients receiving maintenance hemodialysis. Skin autofluorescence was found to be determined (R2=46%) by the Charlson comorbidity index, duration of tobacco use (in years), and serum potassium levels. Skin autofluorescence demonstrated statistically significant correlations with parameters of left ventricular hypertrophy and negative correlations with left ventricular ejection fraction. Death occurred in 38 patients, most commonly due to acute cardiovascular failure (23 patients, 61%). Baseline skin autofluorescence level, combined with serum albumin, alkaline phosphatase, and C-reactive protein levels, yielded a prognostic model for all-cause mortality with 72% sensitivity and 84% specificity. A model incorporating skin autofluorescence changes achieved 89% sensitivity, 91% specificity, and 89.9% predictive accuracy. CONCLUSION: The findings support the use of skin autofluorescence as an integral, independent predictor of all-cause mortality in patients undergoing maintenance hemodialysis. Skin autofluorescence reflects inflammatory and metabolic status, electrolyte imbalances, and cardiovascular remodeling.