Abstract 10923: Indoxyl Sulfate Predicts the Presence of Polyvascular Disease in Patients With Coronary Artery Disease

Abstract

Introduction: Progression of chronic kidney disease (CKD) is associated with extending multiple damaged vascular beds. Data to evaluate the relevance of accumulated uremic toxin for systemic atherosclerosis is limited. In the present study we assessed the clinical role of serum indoxyl sulfate (IS), a protein-bound uremic toxin for the presence of polyvascular disease (PVD) in patients with coronary artery disease (CAD). Methods and Results: We analyzed clinical data from 94 patients who underwent percutaneous coronary intervention for CAD and the prevalence of PVD, defined as 1-, 2- or 3-vessel disease was preoperatively screened. Serum IS levels were determined from blood sample by using high performance liquid chromatograph. Receiver operator characteristic (ROC) curve was used for discriminative ability between elevated IS levels and the presence of PVD. The prevalence of PVD among CAD patients was 38%. The median value of serum IS was 0.103 mg/dl and IS levels were negatively correlated with estimated glomerular filtration rate (e-GFR) (r=0.66 p <0.001). IS levels in PVD patients were significantly higher than in patients who had only CAD (1.171 ± 4.38 mg/dl vs 0.147 ± 0.144 mg/dl, p <0.001) and ROC analysis determined serum IS levels of 0.142 mg/dl as a cut-off value to predict the presence of PVD (sensitivity: 73.4 %, specificity: 79.6%, the area under curve: 0.778). Multivariate analysis found IS (odds ratio [OR]: 6.77, 95% confidence interval [CI] : 1.84-24.9, p=0.003), e-GFR <60 ml/min/1.73m 2 (OR: 5.74, 95% CI : 1.47-22.4, p=0.01) and diabetes mellitus (OR: 4.80, 95% CI: 1.40-16.4, p=0.01) were independently associated with the presence of PVD. Conclusions: IS is an independent predictor of PVD in patients with CAD. This result may contribute to understanding the mechanism of accelerated atherosclerosis in CKD.