Abstract
BackgroundCardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear.MethodsWe conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients.ResultsThe uremic toxins were not associated with inflammatory markers- including high sensitivity C-reactive protein, IL(Interleukin) -1β, IL-6, tumor necrosis factor-α. In multiple linear regression, serum levels of total p-cresol sulfate (PCS) were independently significantly associated with serum total indoxyl sulfate (IS) (standardized coefficient: 0.274, p<0.001), and co-morbidity of diabetes mellitus (DM) (standardized coefficient: 0.342, p<0.001) and coronary artery disease (CAD) (standardized coefficient: 0.128, p = 0.043). The serum total PCS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, p<0.001). Serum levels of total IS was independently significantly associated with serum creatinine (standardized coefficient: 0.285, p<0.001), total PCS (standardized coefficient: 0.239, p = 0.001), and synthetic membrane dialysis (standardized coefficient: 0.139, p = 0.046).ConclusionThe study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total PCS were independently positively significantly associated with co-morbidity of CAD and DM.
Highlights
End stage renal disease (ESRD) patients had higher cardiovascular disease (CVD)-related and all-cause mortality
Many inflammatory cytokines are classified between the uremic toxins in particular tumor necrosis factor (TNF)- a, Interleukin(IL)-6, interleukin - 1 beta (IL-1b) are considered middle molecules as well as b2 microglobulin [6]
Factors associated with serum levels of total indoxyl sulfate (IS) The analysis revealed that the total IS levels were positively associated with male gender, serum levels of blood urea nitrogen (BUN), creatinine, and total P-cresol sulfate (PCS) levels
Summary
End stage renal disease (ESRD) patients had higher cardiovascular disease (CVD)-related and all-cause mortality. Uremic toxins can be classified into small water soluble uremic toxins, middle molecule uremic toxins, and protein bound uremic toxins. P-cresol sulfate (PCS) and indoxyl sulfate (IS) are protein-bound uremic toxins and were associated with endothelial dysfunction immune dysregulation in renal disease [4,5]. Many inflammatory cytokines are classified between the uremic toxins in particular tumor necrosis factor (TNF)- a, Interleukin(IL)-6, IL-1b are considered middle molecules as well as b2 microglobulin [6]. Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. The association between uremic toxins and inflammatory markers in hemodialysis is still unclear
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