Serum p-cresyl sulfate predicts cardiovascular disease and mortality in elderly hemodialysis patients.
BACKGROUND
Previous studies have shown that serum p-cresyl sulfate (PCS) and indoxyl sulfate (IS) were significantly related to clinical outcomes in patients on hemodialysis (HD). However, evidence for the relationship in elderly HD patients remains scarce. We explore whether the two toxins can predict clinical outcomes in elderly HD patients.


METHODS
Fifty stable HD patients more than 65 years old were enrolled from a single medical center. Serum total and free PCS, IS levels and biochemistry were measured concurrently. The clinical outcomes including cardiovascular events and all-cause mortality were analyzed after 38-month follow-up.


RESULTS
Univariate Cox proportional hazard ratio analysis revealed that cardiovascular events were associated with gender (p = 0.02), diabetes (p < 0.01), calcium (p = 0.01), total PCS (p < 0.01), free PCS (p < 0.01) and total IS (p = 0.05). Multivariate analysis showed that diabetes (p = 0.01), total PCS (p = 0.01) and free PCS (p = 0.04) were related to cardiovascular events. For all-cause mortality, only total PCS (p = 0.01) reached significance after adjusting other confounding factors. However, Kaplan-Meier analysis indicated that free PCS (p = 0.02) and total PCS (p < 0.01) were significantly associated with cardiovascular events and total PCS (p = 0.048) was related to all-cause mortality during 38-month follow-up.


CONCLUSIONS
Our results indicate that total PCS is a valuable marker in predicting cardiovascular event and all-cause mortality in elderly HD patients.
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan ; Mackay Medicine, Nursing and Management College, Taipei, Taiwan ; Institute of Biotechnology, National Taipei University of Technology, Taipei, Taiwan.
Cheng-Jui
CJ
Lin
Chih-Kuang
CK
Chuang
Thanasekaran
T
Jayakumar
Hsuan-Liang
HL
Liu
Chi-Feng
CF
Pan
Tuen-Jen
TJ
Wang
Han-Hsiang
HH
Chen
Chih-Jen
CJ
Wu
cardiovascular disease; hemodialysis; indoxyl sulfate; mortality; p-cresyl sulfate