p-Cresol and Cardiovascular Risk in Mild-to-Moderate Kidney Disease
p-Cresol and Cardiovascular Risk in Mild-to-Moderate Kidney Disease
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DOI：
10.2215/cjn.07971109
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发表时间：
2010-07-01
影响因子：
9.8
通讯作者：
Evenepoel, Pieter
中科院分区：
文献类型：
--
作者：
Meijers, Bjorn K. I.;Claes, Kathleen;Evenepoel, Pieter
背景和目的：心血管疾病在慢性肾脏疾病中非常普遍。传统的危险因素不足以解释心血管疾病的高患病率。游离对甲酚血清浓度，主要以其衍生物对甲酚硫酸盐的形式循环，与血液透析患者的心血管疾病相关。目前尚不清楚对甲酚是否与慢性肾脏疾病患者的心血管疾病有关，但尚未透析。设计，设置，参与者和测量：在499例轻度至中度肾脏疾病患者的前瞻性观察研究中，我们检查了对甲酚游离血清浓度和心血管事件之间的多变量关联。结果：平均随访33个月后，62例患者达到了致死性或非致死性心血管事件的主要终点。较高的游离对甲酚基线浓度与心血管事件直接相关（单变量风险比[FIR] 1.79，P < 0.0001）。在多变量分析中，对甲酚仍然是心血管事件的预测因子，独立于GFR和独立于Fracket风险因素（全模型，HR 1.39，P = 0.04）。结论：这些研究结果表明，对甲酚测量可能有助于预测肾脏患者的心血管疾病风险在广泛的残余肾功能，超越传统的肾小球滤过标志物。对甲酚是否是CKD患者中可改变的心血管风险因素仍有待证实。Clin J Am Soc Nephrol 5：1182-1189，2010. doi：10.2215/CJN.07971109
Background and objectives: Cardiovascular disease is highly prevalent in chronic kidney disease. Traditional risk factors are insufficient to explain the high cardiovascular disease prevalence. Free p-cresol serum concentrations, mainly circulating as its derivative p-cresyl sulfate, are associated with cardiovascular disease in hemodialysis patients. It is not known if p-cresol is associated with cardiovascular disease in patients with chronic kidney disease not yet on dialysis.Design, setting, participants, & measurements: In a prospective observational study in 499 patients with mild-to-moderate kidney disease, we examined the multivariate association between p-cresol free serum concentrations and cardiovascular events.Results: After a mean follow-up of 33 mo, 62 patients reached the primary end point of fatal or nonfatal cardiovascular events. Higher baseline concentrations of free p-cresol were directly associated with cardiovascular events (univariate hazard ratio [FIR] 1.79, P < 0.0001). In multivariate analysis, p-cresol remained a predictor of cardiovascular events, independent of GFR and independent of Framingham risk factors (full model, HR 1.39, P = 0.04).Conclusions: These findings suggest that p-cresol measurements may help to predict cardiovascular disease risk in renal patients over a wide range of residual renal function, beyond traditional markers of glomerular filtration. Whether p-cresol is a modifiable cardiovascular risk factor in CKD patients remains to be proven. Clin J Am Soc Nephrol 5: 1182-1189, 2010. doi: 10.2215/CJN.07971109