title: Associations among chronic kidney disease, high total p-cresylsulfate and left ventricular systolic dysfunction.
abstract: BACKGROUND
  A significant number of patients with chronic kidney disease (CKD) have cardiac abnormalities, and left ventricular systolic dysfunction (LVSD) is a common manifestation. p-Cresylsulfate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. Furthermore, the associations among serum total PCS, major adverse cardiovascular events, all-cause mortality, and QTc prolongation have also been found in previous studies. We thus investigated the association of total PCS and CKD with LVSD in the clinical setting.
  
  
  METHODS
  We included 403 consecutive patients with stable angina. To evaluate LV function, all patients underwent echocardiography. To measure the serum total PCS concentrations and estimated glomerular filtration rate (eGFR), blood samples were obtained.
  
  
  RESULTS
  Multiple regression analysis showed that left atrium diameter, left ventricular mass index, end diastolic interventricular septal thickness, left ventricular end-systolic diameter, left ventricular end-systolic volume, stroke volume, left ventricular end-systolic volume index, left ventricular ejection fraction (LVEF), and the interventricular septum/posterior wall of the left ventricle were independently associated with total PCS (all p<0.05). In addition, a significantly decreased LVEF was present in patients with lower and higher serum total PCS and with CKD, and with higher serum total PCS and without CKD than from those with lower serum total PCS concentrations and without CKD (p=0.004). In the multivariate logistic regression analysis, when patients without CKD and lower PCS were used as reference group, patients with the higher total PCS concentration and without CKD had an odds ratio of 3.59 for the risk of LVSD, the lower total PCS concentration and with CKD had an odds ratio of 3.89 for the risk of LVSD, and the higher total PCS concentration and with CKD had an odds ratio of 4.04 for the risk of LVSD (p=0.039, p=0.038, and p=0.020, respectively).
  
  
  CONCLUSIONS
  High serum concentrations of total PCS or CKD, or both, represent an increased risk of impaired LV systolic function in stable angina patients.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Li-Fen
authors.initials: LF
authors.lastname: Lu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC.
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Division of Gastroenterology and Hepatology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Chia-Chang
authors.initials: CC
authors.lastname: Hsu
authors.affiliation: Department of Emergency, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: I-Ting
authors.initials: IT
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Wei-Chin
authors.initials: WC
authors.lastname: Hung
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Teng-Hung
authors.initials: TH
authors.lastname: Yu
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; Institute of Biomedical Engineering, National Cheng Kung University, Tainan, 70101, Taiwan, ROC.
authors.forename: Cheng-Ching
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Fu-Mei
authors.initials: FM
authors.lastname: Chung
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan, ROC.
authors.forename: Yung-Chuan
authors.initials: YC
authors.lastname: Lu
authors.affiliation: Lee's Endocrinologic Clinic, Pingtung 90000, Taiwan, ROC.
authors.forename: Yau-Jiunn
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Division of Cardiology, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan, ROC; School of Medicine for International Students, I-Shou University, Kaohsiung 82445, Taiwan, ROC. Electronic address: ed100232@edah.org.tw.
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003408:Cresols / Q000097:blood*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013463:Sulfuric Acid Esters / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
chemical_list: D003408:Cresols; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate
keywords: Chronic kidney disease; Estimated glomerular filtration rate; Left ventricular systolic dysfunction; Total p-cresylsulfate