title: Serum protein-bound uraemic toxins and clinical outcomes in haemodialysis patients.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Cheng-Jui
authors.initials: CJ
authors.lastname: Lin
authors.forename: Chih-Jen
authors.initials: CJ
authors.lastname: Wu
authors.forename: Chi-Feng
authors.initials: CF
authors.lastname: Pan
authors.forename: Yi-Chou
authors.initials: YC
authors.lastname: Chen
authors.forename: Fang-Ju
authors.initials: FJ
authors.lastname: Sun
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
mesh_terms: 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
chemical_list: D001798:Blood Proteins; D003408:Cresols; C032538:4-cresol; D002097:C-Reactive Protein; D007200:Indican