Koike Hideki, Morita Toshisuke, Tatebe Junko, Watanabe Ippei, Koike Makiko, Yao Shintaro, Shinohara Masaya, Yuzawa Hitomi, Suzuki Takeya, Fujino Tadashi, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Laboratory Medicine, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan.
Heart Vessels. 2019 Apr;34(4):641-649. doi: 10.1007/s00380-018-1288-0. Epub 2018 Nov 8.
Indoxyl sulfate (IS), a protein-bound uremic toxin, induces renal disorders and atrial fibrillation (AF). It is well known that renal dysfunction is a risk factor for AF and radiofrequency catheter ablation (RFCA) improves the renal function. However, the improvement in the renal function after RFCA in patients with early stage chronic kidney disease (CKD) and the serial changes in the IS level have not been fully elucidated. This study aimed to investigate whether IS affects the improvement in the renal function. A total of 91 consecutive patients with mild kidney dysfunction (CKD stage I-II) who underwent RFCA and maintained sinus rhythm were prospectively enrolled. The plasma IS level and estimated glomerular filtration rate (eGFR) were determined before, 3 months, and 1 year after RFCA. The patients were divided according to the IS quartiles (Q1-4; < 0.4, 0.4-0.7, 0.7-1.2, and > 1.2 μg/ml). There was no significant difference in the eGFR among the IS quartiles. A significantly higher eGFR improvement rate was obtained for IS-Q4 than the other quartiles (p = 0.039). The IS-Q4 IS level significantly decreased at 1 year after RFCA (1.8 ± 0.8 to 1.2 ± 0.7 μg/ml, p < 0.01). The multivariable logistic model revealed that a high-IS level (IS-Q4) was an independent predictor of an eGFR improvement (OR 3.33; 95% CI 1.16-9.59; p = 0.026). A high-IS level reduction after RFCA improved the renal function in AF patients with mild kidney dysfunction.
硫酸吲哚酚（IS）是一种与蛋白结合的尿毒症毒素，可引发肾脏疾病和心房颤动（AF）。众所周知，肾功能不全是房颤的一个危险因素，而射频导管消融术（RFCA）可改善肾功能。然而，早期慢性肾脏病（CKD）患者RFCA术后肾功能的改善情况以及IS水平的系列变化尚未完全阐明。本研究旨在探讨IS是否影响肾功能的改善。前瞻性纳入了91例连续接受RFCA且维持窦性心律的轻度肾功能不全（CKD Ⅰ-Ⅱ期）患者。在RFCA术前、术后3个月和1年测定血浆IS水平和估算肾小球滤过率（eGFR）。根据IS四分位数（Q1-4；<0.4、0.4-0.7、0.7-1.2和>1.2μg/ml）对患者进行分组。各IS四分位数组间的eGFR无显著差异。IS-Q4组的eGFR改善率显著高于其他四分位数组（p = 0.039）。RFCA术后1年，IS-Q4组的IS水平显著降低（从1.8±0.8降至1.2±0.7μg/ml，p<0.01）。多变量逻辑模型显示，高IS水平（IS-Q4）是eGFR改善的独立预测因素（OR 3.33；95%CI 1.16-9.59；p = 0.026）。RFCA术后高IS水平的降低改善了轻度肾功能不全房颤患者的肾功能。
