Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Nephrol Dial Transplant. 2012 Mar;27(3):1169-75. doi: 10.1093/ndt/gfr453. Epub 2011 Sep 2.
The mortality rate of elderly hemodialysis (HD) patients is high. Serum p-cresyl sulfate (PCS) and indoxyl sulfate (IS) are associated with cardiovascular (CV) disease and mortality in renal patients. The association between such biomarkers and mortality in elderly HD patients has a high clinical value but remains unclear.
This prospective cohort study investigated the association of serum IS and PCS with all-cause and CV mortality in elderly HD patients. Multivariate Cox regression analysis was used to estimate the risk of all-cause and CV mortality in this prospective cohort.
Of 112 patients, 45 deaths (18 CV deaths) were identified after a mean follow-up of 33.2 months. The cumulative and CV survival of patients with lower free PCS was significantly better than high free PCS patients. In multivariate Cox regression analysis, serum free PCS was associated with all-cause and CV mortality after various adjustments, including age, gender and diabetes status (Model 1), albumin (Model 2), Ca × P product and intact parathyroid hormone (Model 3), hemoglobin and high-sensitivity C-reactive protein (Model 4) and hierarchically selected covariates (age, diabetes status and albumin, Model 5).
Serum free PCS levels may help in predicting risk of all-cause and CV mortality in elderly HD patients beyond traditional and uremia related risk factors.
老年血液透析（HD）患者的死亡率较高。血清对甲苯磺酸（PCS）和吲哚硫酸（IS）与肾脏患者的心血管（CV）疾病和死亡率相关。这些生物标志物与老年 HD 患者死亡率之间的关联具有很高的临床价值，但仍不清楚。
本前瞻性队列研究调查了血清 IS 和 PCS 与老年 HD 患者全因和 CV 死亡率之间的关系。使用多变量 Cox 回归分析来估计该前瞻性队列中全因和 CV 死亡率的风险。
在 112 名患者中，平均随访 33.2 个月后，有 45 例死亡（18 例 CV 死亡）。较低游离 PCS 的患者的累积和 CV 生存率明显好于高游离 PCS 患者。在多变量 Cox 回归分析中，在进行各种调整后，包括年龄、性别和糖尿病状态（模型 1）、白蛋白（模型 2）、Ca×P 产物和完整甲状旁腺激素（模型 3）、血红蛋白和高敏 C 反应蛋白（模型 4）以及分层选择协变量（年龄、糖尿病状态和白蛋白，模型 5）后，血清游离 PCS 与全因和 CV 死亡率相关。
血清游离 PCS 水平可能有助于预测老年 HD 患者全因和 CV 死亡率的风险，超过传统和尿毒症相关的危险因素。
