Lu Yung-Chuan, Wu Cheng-Ching, Tsai I-Ting, Hung Wei-Chin, Lee Thung-Lip, Hsuan Chin-Feng, Yu Teng-Hung, Wei Ching-Ting, Chung Fu-Mei, Lee Yau-Jiunn, Wang Chao-Ping
Division of Endocrinology and Metabolism, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan.
Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan; The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan.
Clin Chim Acta. 2021 May;516:83-91. doi: 10.1016/j.cca.2021.01.015. Epub 2021 Jan 26.
Total p-cresylsulfate (PCS), indoxyl sulfate (IS) and hippuric acid (HA) are harmful uremic toxins known to be elevated in patients with uremia. Serum total PCS, IS and HA levels have been associated with coronary atherosclerosis, left ventricular hypertrophy, metabolic acidosis, neurological symptoms, and accelerated renal damage associated with chronic kidney disease; however, no study has examined the effect of total PCS, IS and HA on hemodialysis (HD) quality indicators. The aim of this study was to examine associations among total PCS, IS and HA with HD quality indicators in patients undergoing HD treatment.
This study included 264 consecutive patients at a single HD center who assessed using previously demonstrated HD quality indicators including anemia, bone-mineral metabolism, dialysis dose, cardiovascular risk, and middle molecule removal area. Serum HA was measured using a capillary electrophoresis method. Serum total PCS and IS concentrations were measured using an Ultra Performance LC System.
Multiple regression analysis showed that sex, potassium, systolic blood pressure (SBP), average BP, β2-microglobulin, and creatinine were independently positively associated with IS level, and that age, total cholesterol, and estimated glomerular filtration rate (eGFR) was independently negatively associated with IS level. In addition, β2-microglobulin was independently positively associated with total PCS. Moreover, potassium, diastolic blood pressure, average BP, β2-microglobulin, dialysis vintage, and albumin were independently positively associated with HA level, and age, transferrin saturation, fasting glucose, and eGFR were independently negatively associated with HA level. When the patients were stratified by age and sex, serum IS and HA levels were still independently associated with some hemodialysis quality indicators. In addition, canonical correlation analysis also confirmed the relationship between uremic toxins (IS and HA) and HD quality indicators (potassium, β2-microglobulin, average BP, creatinine, and eGFR).
This study demonstrated that uremic toxins (IS and HA) and HD quality indicators (potassium, β2-microglobulin, average BP, creatinine, and eGFR) constructs were correlated with each other, and that there were sex and age differences in these associations among maintenance HD patients.
对甲酚硫酸酯（PCS）、硫酸吲哚酚（IS）和马尿酸（HA）是已知在尿毒症患者中水平升高的有害尿毒症毒素。血清总PCS、IS和HA水平与冠状动脉粥样硬化、左心室肥厚、代谢性酸中毒、神经症状以及与慢性肾脏病相关的肾脏损害加速有关；然而，尚无研究探讨总PCS、IS和HA对血液透析（HD）质量指标的影响。本研究旨在探讨接受HD治疗的患者中总PCS、IS和HA与HD质量指标之间的关联。
本研究纳入了一家HD中心的264例连续患者，使用先前证实的HD质量指标进行评估，包括贫血、骨矿物质代谢、透析剂量、心血管风险和中分子清除面积。血清HA采用毛细管电泳法测定。血清总PCS和IS浓度采用超高效液相色谱系统测定。
多元回归分析显示，性别、钾、收缩压（SBP）、平均血压、β2-微球蛋白和肌酐与IS水平独立正相关，年龄、总胆固醇和估计肾小球滤过率（eGFR）与IS水平独立负相关。此外，β2-微球蛋白与总PCS独立正相关。而且，钾、舒张压、平均血压、β2-微球蛋白、透析龄和白蛋白与HA水平独立正相关，年龄、转铁蛋白饱和度、空腹血糖和eGFR与HA水平独立负相关。当按年龄和性别对患者进行分层时，血清IS和HA水平仍与一些血液透析质量指标独立相关。此外，典型相关分析也证实了尿毒症毒素（IS和HA）与HD质量指标（钾、β2-微球蛋白、平均血压、肌酐和eGFR）之间的关系。
本研究表明，尿毒症毒素（IS和HA）与HD质量指标（钾、β2-微球蛋白、平均血压、肌酐和eGFR）之间相互关联，且维持性HD患者中这些关联存在性别和年龄差异。
