Document Detail

The role of protein-bound uremic toxins on peripheral artery disease and vascular access failure in patients on hemodialysis.
MedLine Citation:
PMID:  22981405     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: p-Cresyl sulfate (PCS) and indoxyl sulfate (IS) have been reported to predict poor clinical outcomes in hemodialysis (HD) patients. However, little is known about the effect of the two toxins on peripheral arterial disease (PAD) and vascular access dysfunction. Our objective was to explore the association between the two toxins and PAD and vascular access failure (VAF) in a hemodialysis-based cohort.
METHODS: We enrolled 100 stable and eligible HD patients from a single medical center. These patients were screened for PAD by machine and recorded as ABI (ankle brachial index) and brachial-ankle PWV (pulse wave velocity). Serum levels of PCS, IS and biochemical data were also collected concurrently. In addition, we also recorded the first event of VAF and frequency of PTA and thrombectomy during 3-year follow-up.
RESULTS: Total and free PCS were correlated to right and left ABI and PWV (p < 0.01), and total IS was associated with right and left ABI (p < 0.01) by Pearson's analysis. Repeated measuring by mixed model analysis revealed that serum albumin (p = 0.003), cholesterol (p = 0.01) and total PCS (p = 0.031) had significant correlation with ABI after adjusting other confounding factors. As for brachial-ankle PWV, serum triglyceride (p = 0.002), total IS (p = 0.04) and total PCS (p = 0.050) reached significance finally. In addition, multivariate Cox regression analysis revealed dialysis length and total PCS were related to AV-shunt failure event (Hazard Ratio: 1.14, p = 0.01, and Hazard Ratio: 1.04, p = 0.04, respectively). Both of total and free PCS and IS were also positively linked to numbers of PTA and thrombectomy. Further, the Kaplan-Meier analysis showed only total PCS was significantly associated with vascular access failure event (log rank P = 0.02).
CONCLUSION: This study shows that the serum levels of PCS and IS were associated with PAD and total PCS could be a valuable determinant of access viability other than traditional or nontraditional risk factors in HD patients.
Cheng-Jui Lin; Chi-Feng Pan; Hsuan-Liang Liu; Chih-Kuang Chuang; Thanasekaran Jayakumar; Tuen-Jen Wang; Han-Hsiang Chen; Chih-Jen Wu
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-08-28
Journal Detail:
Title:  Atherosclerosis     Volume:  225     ISSN:  1879-1484     ISO Abbreviation:  Atherosclerosis     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  2013-04-11     Revised Date:  2013-07-16    
Medline Journal Info:
Nlm Unique ID:  0242543     Medline TA:  Atherosclerosis     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  173-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
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MeSH Terms
Ankle Brachial Index
Cresols / blood*
Equipment Failure*
Indican / blood*
Middle Aged
Peripheral Arterial Disease
Pulse Wave Analysis
Renal Dialysis / adverse effects
Toxins, Biological / blood*
Vascular Access Devices / adverse effects*
Reg. No./Substance:
0/4-cresol sulfate; 0/Cresols; 0/Toxins, Biological; 0/uremia middle molecule toxins; 487-94-5/Indican

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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