title: Serum Indoxyl Sulfate Associates with Postangioplasty Thrombosis of Dialysis Grafts.
abstract: Hemodialysis vascular accesses are prone to recurrent stenosis and thrombosis after endovascular interventions.In vitro data suggest that indoxyl sulfate, a protein-bound uremic toxin, may induce vascular dysfunction and thrombosis. However, there is no clinical evidence regarding the role of indoxyl sulfate in hemodialysis vascular access. From January 2010 to June 2013, we prospectively enrolled patients undergoing angioplasty for dialysis access dysfunction. Patients were stratified into tertiles by baseline serum indoxyl sulfate levels. Study participants received clinical follow-up at 6-month intervals until June 2014. Primary end points were restenosis, thrombosis, and failure of vascular access. Median follow-up duration was 32 months. Of the 306 patients enrolled, 262 (86%) had symptomatic restenosis, 153 (50%) had access thrombosis, and 25 (8%) had access failure. In patients with graft access, free indoxyl sulfate tertiles showed a negative association with thrombosis-free patency (thrombosis-free patency rates of 54%, 38%, and 26% for low, middle, and high tertiles, respectively;P=0.001). Patients with graft thrombosis had higher free and total indoxyl sulfate levels. Using multivariate Cox regression analysis, graft thrombosis was independently predicted by absolute levels of free indoxyl sulfate (hazard ratio=1.14;P=0.01) and free indoxyl sulfate tertiles (high versus low, hazard ratio=2.41;P=0.001). Results of this study provide translational evidence that serum indoxyl sulfate is a novel risk factor for dialysis graft thrombosis after endovascular interventions.
authors.affiliation: Cardiovascular Center and Institute of Biomedical Engineering, National Tsing-Hua University, Taipei, Taiwan; College of Medicine and School of Medicine.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Cardiovascular Center and College of Medicine and.
authors.forename: Mu-Yang
authors.initials: MY
authors.lastname: Hsieh
authors.affiliation: Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; Buddhist Tzu Chi University, Hualien, Taiwan;
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Hung
authors.affiliation: Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; Buddhist Tzu Chi University, Hualien, Taiwan;
authors.forename: Ko-Lin
authors.initials: KL
authors.lastname: Kuo
authors.affiliation: Institute of Traditional Medicine.
authors.forename: Tung-Hu
authors.initials: TH
authors.lastname: Tsai
authors.affiliation: Emergency and Critical Care Center, National Taiwan University Hospital, Hsinchu Branch, Taipei, Taiwan; Cardiovascular Research Center, and.
authors.forename: Chao-Lun
authors.initials: CL
authors.lastname: Lai
authors.affiliation: Department of Medical Research and Institute and Department of Pharmacology and Cardiovascular Research Center.
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.affiliation: Department of Medical Research and Institute of Clinical Medicine and Cardiovascular Research Center, Taipei Medical University, Taipei, Taiwan; and.
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital and Institute of Clinical Medicine, Taipei, Taiwan Cardiovascular Research Center, and huangbs@vghtpe.gov.tw dctarng@vghtpe.gov.tw.
authors.forename: Po-Hsun
authors.initials: PH
authors.lastname: Huang
authors.affiliation: Institutes of Physiology and Clinical Medicine, Genome Research and Infection and Immunity Centers, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; huangbs@vghtpe.gov.tw dctarng@vghtpe.gov.tw.
authors.forename: Der-Cherng
authors.initials: DC
authors.lastname: Tarng
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D007200:Indican / Q000097:blood*; D008297:Male; D011446:Prospective Studies; D006435:Renal Dialysis; D013927:Thrombosis / Q000097:blood* / Q000209:etiology*; D014654:Vascular Patency
chemical_list: D007200:Indican
keywords: arteriovenous shunt; hemodialysis access; thrombosis