title: Free p-cresol sulfate is associated with survival and function of vascular access in chronic hemodialysis patients.
abstract: BACKGROUND
  Protein-bound uremic toxins indoxyl sulfate (IS) and p-cresol sulfate (p-CS) have been implicated as an important factor in uremic syndrome. Recent evidence indicates that both IS and p-CS are predictors of cardiovascular as well as all-cause mortality among chronic dialysis patients. We conducted a study to analyze the relationship between IS and p-CS and vascular access (VA) outcome in chronic hemodialysis (HD) patients.
  
  
  METHODS
  A total of 91 chronic stable HD patients were divided into groups according to survival of VA and frequency of VA dysfunction. Demographic and biochemical data were reviewed and recorded. Serum levels of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1, and the total and free forms of IS and p-CS were determined.
  
  
  RESULTS
  Patients with a history of frequent VA failure and dysfunction had lower albumin and higher levels of ICAM-1, free IS, free and total p-CS. Diabetes was associated with higher IS and p-CS. Logistic regression revealed that diabetes and free p-CS were independent factors associated with poor outcome of VA.
  
  
  CONCLUSIONS
  Endothelial dysfunction and uremic toxins were associated with survival and function of VA. Diabetes and free p-CS were significantly related to the outcome of VA among chronic HD patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Te-Chuan
authors.initials: TC
authors.lastname: Chen
authors.forename: Chun-Yeh
authors.initials: CY
authors.lastname: Wang
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Hsu
authors.forename: Chien-Hsing
authors.initials: CH
authors.lastname: Wu
authors.forename: Chien-Chun
authors.initials: CC
authors.lastname: Kuo
authors.forename: Ku-Chung
authors.initials: KC
authors.lastname: Wang
authors.forename: Chih-Chau
authors.initials: CC
authors.lastname: Yang
authors.forename: Men-Tai
authors.initials: MT
authors.lastname: Wu
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Chuang
authors.forename: Chien-Te
authors.initials: CT
authors.lastname: Lee
mesh_terms: D015415:Biomarkers / Q000097:blood; D003408:Cresols / Q000097:blood*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D013463:Sulfuric Acid Esters / Q000097:blood*; D062666:Vascular Access Devices / Q000009:adverse effects / Q000639:trends*
chemical_list: D015415:Biomarkers; D003408:Cresols; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate