Abstract
Clearance of protein-bound uremic toxins (PBUTs) by dialysis is a challenge in the treatment of uremic patients. Shen-Shuai-Ning (SSN), a traditional Chinese medicine formulation, has been used commonly in China to retard kidney disease progression and decrease uremic toxins in chronic kidney disease (CKD) patients, but the effects of SSN on serum PBUTs in dialysis patients were not investigated. We conducted a randomized controlled trial in patients on peritoneal dialysis (PD) at dialysis center of Changzheng Hospital to evaluate the effects of SSN on serum PBUTs. Participants with SSN intervention took 5 g SSN granule three times daily for 12 weeks, while the baseline medications and dialysis prescriptions remained during the study in all patients. The serum concentrations of indoxyl sulphate (IS) and p-cresol sulphate (PCS) were determined by HPLC/MS/MS and biochemical parameters were assessed during the study. Sixty PD patients were enrolled and randomly allocated into SSN group and control group. Total IS level was significantly lower in SSN group than in control group at week 4, 8, and 12 (27.28 ± 18.19, 29.73 ± 19.10, and 29.41 ± 17.61 mg/l compared with 39.25 ± 20.23, 44.86 ± 23.91, and 45.34 ± 33.52 mg/l, respectively). However, there were no statistical difference of total PCS, free forms of IS and PCS concentrations between SSN group and control group during 12 weeks follow-up. Administration of SSN granule orally decreased serum total IS level effectively in uremic patients on PD with good tolerance. Benefits of PD patients’ outcomes from IS reduction by SSN awaits further large size and long duration clinical trials to verify.
Highlights
Chronic kidney disease (CKD) is associated with dramatically increased risk of cardiovascular disease due to complex pathophysiologic responses to declining kidney function [1,2,3]
Sixty peritoneal dialysis (PD) patients from PD Center of Changzheng Hospital were recruited between 1 February 2015 and 28 February 2016, and 30 of them were randomized to SSN group and 30 to control group
The causes of end-stage renal disease (ESRD), duration of PD, body mass index (BMI), and blood pressure were comparable between two groups (Table 1)
Summary
Chronic kidney disease (CKD) is associated with dramatically increased risk of cardiovascular disease due to complex pathophysiologic responses to declining kidney function [1,2,3]. A growing number of publications suggested that indoxyl sulphate (IS) and p-cresol sulphate (PCS), two types of most investigated PBUTs, had direct deleterious effects on a variety of organs. They could inhibit blood vessel endothelial proliferation and migration [7], increase ROS, and decrease NO production [8] leading to endothelial dysfunction. Previous studies documented the negative impact c 2018 The Author(s).
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