title: Associations among chronic kidney disease, high total p-cresylsulfate and major adverse cardiac events.
abstract: BACKGROUND
  Cardiovascular disease is prevalent among patients with chronic kidney disease (CKD). Patients with CKD have elevated levels of p-cresylsulfate (PCS), which has been linked with cardiovascular mortality in this population. The aim of this study was to evaluate the clinical significance of CKD in coronary artery disease (CAD) patients and to investigate whether a significant correlation exists between CKD, total PCS and poor clinical outcomes in CAD patients.
  
  
  METHODS
  We assessed the occurrence of major adverse cardiac events (MACEs) among 340 consecutive CAD patients who enrolled in a disease management program after the patients were discharged from the hospital. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 ml/min per 1.73 m(2).
  
  
  RESULTS
  Kaplan-Meier analysis revealed that CKD and high total PCS levels (>1.66 mg/L) were significantly associated with the occurrence of MACE. A multivariate Cox hazard regression model revealed that the predictive independent risk factor for the occurrence of MACE was high total PCS level (relative risk = 1.387). We divided the patients with or without CKD and high or low total PCS levels into 4 groups according to their eGFR and total PCS levels, respectively. The hazard ratio for MACE in the group with both CKD and high total PCS level was 1.721, relative to the group without CKD that had low total PCS level (p=0.005).
  
  
  CONCLUSIONS
  A high serum level of total PCS may be a predictor of elevated risk of MACE in CAD patients with low eGFR.
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Wang
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: Cheng-An
authors.initials: CA
authors.lastname: Chiu
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Chung
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Hsu
authors.forename: Yung-Chuan
authors.initials: YC
authors.lastname: Lu
authors.forename: Yau-Jiunn
authors.initials: YJ
authors.lastname: Lee
authors.forename: Jer-Yiing
authors.initials: JY
authors.lastname: Houng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications*; D003408:Cresols / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D013463:Sulfuric Acid Esters / Q000097:blood*
chemical_list: D003408:Cresols; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate