Serum protein-bound uraemic toxins and clinical outcomes in haemodialysis patients.
BACKGROUND
The protein-bound uraemic toxin p-cresol is associated with immunodeficiency in haemodialysis (HD) patients. We investigated the effect of serum p-cresol, indoxyl sulphate and other variables on clinical outcomes in HD patients during a 20-month follow-up.


METHODS
We enrolled 100 stable HD patients from a single medical centre. The primary outcomes were infection-related hospitalization, cardiovascular events and all-cause mortality. Serum total and free p-cresol and indoxyl sulphate levels were measured using ultra-performance liquid chromatography. Biochemical data were collected concurrently.


RESULTS
Multivariate logistic regression analysis revealed that infection-related hospitalization correlated with free p-cresol (adjusted odds ratio: 1.70, P = 0.01) and highly sensitive C-reactive protein (hsCRP) (adjusted odds ratio: 2.07, P = 0.01); cardiovascular event was associated with free p-cresol (adjusted odds ratio: 1.78, P = 0.01) and nPCR (adjusted odds ratio: 0.01, P = 0.02); and all-cause mortality was related to albumin (adjusted odds ratio: 0.04, P = 0.01). The Kaplan-Meier method showed that free and total p-cresol were significantly associated with cardiovascular events (log-rank P < 0.01 and log-rank P < 0.01, respectively). Serum free p-cresol seemed to have a trend to correlate with infection-related hospitalization during a 20-month follow-up (log-rank P = 0.05).


CONCLUSIONS
Serum free and total p-cresol levels were significantly related to cardiovascular events. In addition, serum free p-cresol and hsCRP levels were also found to be associated with infection-related hospitalization.
Lin
Cheng-Jui
CJ
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Wu
Chih-Jen
CJ
Pan
Chi-Feng
CF
Chen
Yi-Chou
YC
Sun
Fang-Ju
FJ
Chen
Han-Hsiang
HH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000378:metabolism*; D002097:C-Reactive Protein / Q000032:analysis; D003408:Cresols / Q000097:blood*; D005260:Female; D006801:Humans; D007200:Indican / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D017595:Renal Plasma Flow
D001798:Blood Proteins; D003408:Cresols; C032538:4-cresol; D002097:C-Reactive Protein; D007200:Indican