CONSEQUENCES OF ADVANCES GLYCATION END PRODUCTS ACCUMULATION AND CLINICAL USEFULNESS OF THEIR ASSESSMENT USING A NON-INVASIVE TECHNIQUE
Accelerated formation and accumulation of advanced glycation end-products (AGEs) occur under circumstances of increased supply of substrates such as hyperglycaemic or oxidative stress and in age-related and chronic diseases like diabetes mellitus, chronic renal failure, neurodegenerative diseases, osteoarthritis and also non-diabetic atherosclerosis and chronic heart failure. AGEs accumulation occurs specially on long-lived proteins such as collagen in the skin and in vascular basement membranes leading to vascular damage. Adequate renal clearance capacity is an important factor in the effective removal of AGEs. Autofluorescence Reader (AFR) was developed to provide a marker representative for tissue AGE-accumulation to be easily applicable in a clinical setting initially for predicting diabetes related complications. Studies have already shown a relationship between skin autofluorescence and diabetes complications, as well as the predictive value of skin autofluorescence for total and cardiovascular mortality in type 2 diabetes. Moreover skin AF was demonstrated to be superior to HbA1c and other conventional risk factors. AGEs have been proposed as a novel factor involved in the development and progression of chronic heart failure. Assessment of AGEs accumulation in end-stage renal disease (ESRD) and undergoing renal replacement therapies patients became of great importance. Cardiovascular and connective tissue disorders are very common in patients with ESRD, and the accumulation of AGEs is significantly increased in these patients. Mortality is markedly increased in patients with decreased kidney function, particularly in patients with ESRD. Skin AGEs levels are strong predictors of survival in haemodialysis patients independent of other established risk factors. The AFR may be useful as a clinical tool for rapid assessment of risk for AGEs related long-term complications, not only in diabetes, but in other conditions associated with AGEs accumulation as well.