title: Increased levels of total P-Cresylsulphate and indoxyl sulphate are associated with coronary artery disease in patients with diabetic nephropathy.
abstract: BACKGROUND
  Indoxyl sulphate (IS) and p-cresylsulphate (PCS) are uremic toxins with similar protein-binding, dialytic clearance, and proinflammatory features. Few studies have evaluated the possible associations between these solutes and coronary artery disease (CAD) in type 2 diabetes (T2D) patients.
  
  
  METHODS
  A hospital-based case control study was performed. A total of 209 T2D patients were divided into two groups based on the presence/absence of significant CAD (≥50% luminal reduction). Serum total PCS and IS levels were measured using the Ultra Performance LC System. The relationship between total PCS and IS levels were investigated. Coronary calcium scores and the modified Gensini score were analyzed.
  
  
  RESULTS
  Serum total PCS and IS levels were significantly higher in patients with both T2D and significant CAD, than in non-diabetic control subjects and T2D patients without CAD (all p < 0.05). Logistic regression analysis revealed independent and significant associations between the two solutes and CAD status. Serum total PCS, IS, and numbers of diseased vessels were elevated in groups with estimated glomerular filtration rate (eGFR) of 60-89 ml/min/1.73 m2 and below. Also, serum total PCS and IS levels were significantly associated with eGFR, coronary calcium scores, Gensini score, adipocytokines (adiponectin, visfatin, and leptin), and total white blood cell count.
  
  
  CONCLUSIONS
  Serum total PCS and IS levels were elevated in patients with T2D and CAD. These increases were associated with renal function deterioration, inflammation, and coronary atherosclerosis.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Cheng-An
authors.initials: CA
authors.lastname: Chiu
authors.forename: Li-Fen
authors.initials: LF
authors.lastname: Lu
authors.forename: Teng-Hung
authors.initials: TH
authors.lastname: Yu
authors.forename: Wei-Chin
authors.initials: WC
authors.lastname: Hung
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Chung
authors.forename: I-Ting
authors.initials: IT
authors.lastname: Tsai
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Yang
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Hsu
authors.forename: Yung-Chuan
authors.initials: YC
authors.lastname: Lu
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Wang
authors.forename: Yau-Jiunn
authors.initials: YJ
authors.lastname: Lee
mesh_terms: D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000209:etiology* / Q000378:metabolism; D003408:Cresols / Q000097:blood*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007200:Indican / Q000097:blood*; D008297:Male; D008875:Middle Aged; D013463:Sulfuric Acid Esters
chemical_list: D003408:Cresols; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate; D007200:Indican