Skin-Autofluorescence, a Measure of Tissue Advanced Glycation End-Products (AGEs), is Related to Diastolic Function in Dialysis Patients

Background: Diastolic dysfunction is a frequent cause of heart failure, particularly in dialysis patients. Advanced glycation endproducts (AGEs) are increased in dialysis patients and are suggested to play a role in the development of diastolic dysfunction. The aim of our study was to assess whether AGE accumulation in dialysis patients is related to the presence of diastolic dysfunction. Methods and Results: Data were analyzed from 43 dialysis patients, age 58 ± 15 years, of whom 65% were male. Diastolic function was assessed using tissue velocity imaging (TVI) on echocardiography. Tissue AGE accumulation was measured using a validated skin-autofluorescence (skin-AF) reader. Plasma N^ε{lunate}-(carboxymethyl)lysine (CML) and N^ε{lunate}-(carboxyethyl)lysine (CEL) were measured by stable-isotope-dilution tandem mass spectrometry. Plasma pentosidine was measured by high-performance liquid chromatography. Skin-AF correlated with mean E′ (r = -0.51, P < .001), E/A ratio (r = -0.39, P = .014), and E/E′ (r = 0.38, P = .019). Plasma AGEs were not significantly associated with diastolic function. Multivariable linear regression analysis revealed that 54% of the variance of average E′ was explained by age (P = .007), dialysis type (P = 0.016), and skin-AF (P = .013). Conclusions: Tissue AGEs measured as skin-AF, but not plasma AGE levels, were related to diastolic function in dialysis patients. Although this may support the concept that tissue AGEs explain part of the increased prevalence of diastolic dysfunction in these patients, the ambiguous relation between plasma and tissue AGEs needs further exploring.