MON-636 - Skin Autofluorescence and DFA-Α1 Are Complementarily Associated with Reduced Estimated Glomerular Filtration Rate in Type 2 Diabetes: A Cross-Sectional Study

Background: Reduced kidney function in type 2 diabetes reflects cumulative metabolic injury and multisystem physiological dysregulation. Skin autofluorescence (SAF) provides a noninvasive estimate of tissue advanced glycation end-product burden, whereas detrended fluctuation analysis of short-term heart rate variability (DFA-α1) captures fractal autonomic dynamics. Whether DFA-α1 provides information complementary to SAF beyond chronological age in identifying reduced estimated glomerular filtration rate (eGFR) remains unclear.

Methods: We conducted a cross-sectional study of 107 adults with type 2 diabetes. SAF was measured using a validated autofluorescence-based device, and resting 5-minute electrocardiograms were recorded under standardized resting conditions. DFA-α1 was prespecified as the primary nonlinear autonomic index. Reduced kidney function was defined as eGFR < 60 mL/min/1.73 m². Associations were examined using parsimonious logistic regression models with hierarchical adjustment, including age-adjusted analyses and sensitivity models incorporating sex and key covariates. Discrimination was assessed using receiver operating characteristic analysis.

Results: Reduced eGFR was observed in a clinically relevant subset of participants. Higher SAF was associated with increased odds of reduced eGFR (OR 2.24, 95% CI 1.07–4.71; p=0.033; AUC 0.66). Higher DFA-α1 was associated with lower odds of reduced eGFR (AUC 0.64). The combined model including SAF and DFA-α1 modestly improved discrimination (AUC 0.69). After age adjustment, the association between SAF and reduced eGFR was attenuated, whereas DFA-α1 remained independently associated (adjusted OR 0.22, 95% CI 0.05–0.93; p=0.039).

Conclusion: In adults with type 2 diabetes, SAF and DFA-α1 show complementary associations with reduced eGFR. While the association of SAF appears largely age-dependent, DFA-α1 remains associated after age adjustment, suggesting that autonomic fractal dynamics may provide information beyond metabolic glycation burden and chronological aging. These findings support a multidimensional, noninvasive phenotyping approach for kidney function in diabetes.

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