Journal Article

<i>p</i>-Cresyl sulphate and indoxyl sulphate predict progression of chronic kidney disease

I-Wen Wu, Kuang-Hung Hsu, Chin-Chan Lee, Chiao-Yin Sun, Heng-Jung Hsu, Chi-Jen Tsai, Chin-Yuan Tzen, Yen-Chih Wang, Ching-Yuang Lin and Mai-Szu Wu

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 3, pages 938-947
Published in print March 2011 | ISSN: 0931-0509
Published online September 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq580

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Background. Indoxyl sulphate (IS) and p-cresyl sulphate (PCS) are uraemic toxins that have similar protein binding, dialytic clearance and proinflammatory features. However, only a few prospective studies have evaluated possible associations between these two retained solutes and renal disease progression in chronic kidney disease (CKD) patients.

Methods. This prospective observational study evaluated independent associations between serum total IS and PCS with renal progression in a selected cohort of patients having different stages of CKD. Baseline PCS and IS were correlated with renal progression [defined as decrements in estimated glomerular filtration rate (eGFR) > 50% from baseline or progression to end-stage renal disease (ESRD)] and death during a follow-up period of 24 months.

Results. Of 268 patients, 35 (13.1%) had renal progression and 14 (5.2%) died after a mean follow-up of 21 ± 3 months. Univariate Cox regression analysis followed by multivariate analysis showed that high-serum PCS levels were associated with renal progression and all-cause mortality independent of age, gender, diabetes status, albumin levels, serum IS, serum creatinine, Ca × P product, intact parathyroid hormone, haemoglobin or high-sensitivity C-reactive protein level. Serum IS was only associated with renal progression; however, the predictive power of serum IS was weakened when serum PCS was also present in the analytical model.

Conclusions. In addition to traditional and uraemia-related risk factors such as renal function, serum IS and PCS levels may help in predicting the risk of renal progression in patients having different stages of CKD.

Keywords: chronic kidney disease; indoxyl sulphate; p-cresyl sulphate; protein-bound toxins; proximal tubule

Journal Article.  5066 words.  Illustrated.

Subjects: Nephrology

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