title: Role of anuria in the relationship between indoxyl sulfate and anemia in peritoneal dialysis patients.
abstract: BACKGROUND
  Experimental evidence suggests that indoxyl sulfate (IS) is associated with chronic kidney disease-related anemia. However, clinical studies are limited, and few have explored the potential confounding effect of anuria. This study, thus, evaluated the association between IS and anemia in both non-anuric and anuric peritoneal dialysis (PD) patients.
  
  
  METHODS
  This cross-sectional and observational study included 165 chronic PD patients aged 19-84 years. Their serum IS levels in total and free forms were measured by ultra performance liquid chromatography. Correlations between serum IS and hemoglobin (Hb) were performed in both non-anuric and anuric groups.
  
  
  RESULTS
  Among the study subjects, 90 were non-anuric and 75 were anuric. As a whole, there was no correlation between IS and Hb. Nonetheless, subsequent analysis of the non-anuric patients showed that Hb is negatively correlated with IS levels (rs=-0.405,P<0.001 for total form andrs=-0.296,P=0.005 for free form). Factors that significantly affected Hb levels in the stepwise multiple regression analysis include total IS and iron saturation. In contrast for anuric patients, serum ferritin, albumin, iron saturation, use of angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, but not serum IS, were predictors for anemia in the multiple regression model.
  
  
  CONCLUSIONS
  Serum IS is associated with an increased severity of anemia in non-anuric PD patients and not in anuric ones, indicating anuria could be a confounding factor in such association.
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taipei; Chang Gung University School of Medicine, Taoyuan, Taiwan.
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Huang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taipei; Chang Gung University School of Medicine, Taoyuan, Taiwan.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taipei; Chang Gung University School of Medicine, Taoyuan, Taiwan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Yang
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taipei; Chang Gung University School of Medicine, Taoyuan, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taipei; Chang Gung University School of Medicine, Taoyuan, Taiwan.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
keywords: anemia; anuria; indoxyl sulfate; peritoneal dialysis