title: The association of uremic toxins and inflammation in hemodialysis patients.
abstract: BACKGROUND
  Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear.
  
  
  METHODS
  We conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients.
  
  
  RESULTS
  The uremic toxins were not associated with inflammatory markers--including high sensitivity C-reactive protein, IL(Interleukin) -1β, IL-6, tumor necrosis factor-α. In multiple linear regression, serum levels of total p-cresol sulfate (PCS) were independently significantly associated with serum total indoxyl sulfate (IS) (standardized coefficient: 0.274, p<0.001), and co-morbidity of diabetes mellitus (DM) (standardized coefficient: 0.342, p<0.001) and coronary artery disease (CAD) (standardized coefficient: 0.128, p = 0.043). The serum total PCS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, p<0.001). Serum levels of total IS was independently significantly associated with serum creatinine (standardized coefficient: 0.285, p<0.001), total PCS (standardized coefficient: 0.239, p = 0.001), and synthetic membrane dialysis (standardized coefficient: 0.139, p = 0.046).
  
  
  CONCLUSIONS
  The study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total PCS were independently positively significantly associated with co-morbidity of CAD and DM.
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan; The Graduate Institute of Clinical Medical Sciences, Chang Gung University Medical College, Taoyuan School of Medicine, Taoyuan, Taiwan.
authors: Heng-Jung
authors: HJ
authors: Hsu
authors: Department of Pediatrics, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Chiung-Hui
authors: CH
authors: Yen
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: I-Wen
authors: IW
authors: Wu
authors: Laboratory of Epidemiology, Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan.
authors: Kuang-Hung
authors: KH
authors: Hsu
authors: Division of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chih-Ken
authors: CK
authors: Chen
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chiao-Yin
authors: CY
authors: Sun
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chia-Chi
authors: CC
authors: Chou
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chun-Yu
authors: CY
authors: Chen
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chi-Jen
authors: CJ
authors: Tsai
authors: Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Internal Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Mai-Szu
authors: MS
authors: Wu
authors: Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors: Chin-Chan
authors: CC
authors: Lee
mesh_terms: D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D003408:Cresols / Q000097:blood*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology; D005260:Female; D006801:Humans; D007200:Indican / Q000097:blood*; D007249:Inflammation / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D013463:Sulfuric Acid Esters / Q000097:blood*
chemical_list: D003408:Cresols; D018836:Inflammation Mediators; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate; D003404:Creatinine; D007200:Indican