Serum Indoxyl Sulfate Is Associated with Vascular Disease and Mortality in Chronic Kidney Disease Patients
Serum Indoxyl Sulfate Is Associated with Vascular Disease and Mortality in Chronic Kidney Disease Patients
复制标题
DOI：
10.2215/cjn.03980609
复制
发表时间：
2009-10-01
影响因子：
9.8
通讯作者：
Massy, Ziad A.
中科院分区：
文献类型：
--
作者：
Barreto, Fellype C.;Barreto, Daniela V.;Massy, Ziad A.
背景和目的：作为尿毒症综合征的主要组成部分，心血管疾病是慢性肾脏疾病（CKD）中观察到的高死亡率的主要原因。临床前研究已证实血清硫酸吲哚酚（IS，一种蛋白结合的尿毒症毒素）水平与血管改变之间存在关联。本研究的目的是调查血清is、血管钙化、血管僵硬和CKD患者死亡率之间的关系。设计、设置、参与者和测量：纳入了不同阶段CKD的139例患者（平均+/- SD年龄：67 +/- 12岁；60%为男性）（2期8%，3期26.5%，4期26.5%，5期7%，5D期32%）。结果：基线IS水平与肾功能呈反比关系，与主动脉钙化和脉波速度呈直接关系。在随访期间（605 +/- 217 d）， 25例患者死亡，主要原因是心血管事件（n = 18）。在粗生存分析中，最高IS分值是总体死亡率和心血管死亡率的有力预测因子（P分别为0.001和0.012）。在调整了年龄、性别、糖尿病、白蛋白、血红蛋白、磷酸盐和主动脉钙化等因素后，IS对死亡的预测能力仍然维持不变。结论：本研究提示IS可能在CKD患者的血管疾病和较高的死亡率中起重要作用。中国临床医学杂志，2009,31(4):551- 558。doi: 10.2215 / CJN.03980609
Background and objectives: As a major component of uremic syndrome, cardiovascular disease is largely responsible for the high mortality observed in chronic kidney disease (CKD). Preclinical studies have evidenced an association between serum levels of indoxyl sulfate (IS, a protein-bound uremic toxin) and vascular alterations. The aim of this study is to investigate the association between serum IS, vascular calcification, vascular stiffness, and mortality in a cohort of CKD patients.Design, setting, participants, & measurements: One-hundred and thirty-nine patients (mean +/- SD age: 67 +/- 12; 60% male) at different stages of CKD (8% at stage 2, 26.5% at stage 3, 26.5% at stage 4, 7% at stage 5, and 32% at stage 5D) were enrolled.Results: Baseline IS levels presented an inverse relationship with renal function and a direct relationship with aortic calcification and pulse wave velocity. During the follow-up period (605 +/- 217 d), 25 patients died, mostly because of cardiovascular events (n = 18). In crude survival analyses, the highest IS tertile was a powerful predictor of overall and cardiovascular mortality (P = 0.001 and 0.012, respectively). The predictive power of IS for death was maintained after adjustment for age, gender, diabetes, albumin, hemoglobin, phosphate, and aortic calcification.Conclusions: The study presented here indicates that IS may have a significant role in the vascular disease and higher mortality observed in CKD patients. Clin J Ain Soc Nephrol 4: 1551-1558, 2009. doi: 10.2215/CJN.03980609