p-cresol: correlation with glomerular filtration rate and outcome in chronic kidney disease

Conditions: Risk Factors; Renal Progression; Death

Summary: end-stage renal disease is a global epidemia with an estimated incidence of 7% per year and high morbidity-mortality rate. early detection of chronic kidney disease (ckd) and intervention for ckd complication is important to retard renal progression. however, "traditional uremic toxin" or "small water-soluble molecules" are poorly correlated with the renal function, uremic symptoms and outcomes of ckd patients. putative protein-bound solute, p-cresol, is accumulated in esrd patients receiving dialysis therapy. this uremic solute was associated with endothelial dysfunction, immune dysregulation and can predict outcome in hemodialysis patient. p-cresol inhibits endothelial cell proliferation and endothelial response to inflammatory cytokines. in vitro, p-cresol decreases leukocyte transendotherliar migratory function and inhibit production of phagocyte reactive species. clinically, p-cresol plays a pathophysiological role in the uremic toxicity. high free serum level of p-cresol is associated with mortality in hemodialysis patients. information of p-cresol in ckd patients is not available. the investigators hypothesized p-cresol can be accumulated in early ckd and have a positive correlation with the morbidity- mortality of ckd patients. value of p-cresol in different stages of crf is still unknown. information of p-cresol in ckd patients is not available. the investigators hypothesized p-cresol can be accumulated in early ckd and have a positive correlation with the morbidity- mortality of ckd patients. the principal aim of this prospective cohort study is to investigate the association between total serum levels of p-cresol and the glomerular filtration rate. the correlation of level of p-cresol and morbidity-mortality in ckd patients will be also evaluated. to determine the relationship, patients of nephrology clinic with a diagnosis of ckd were enrolled in this prospective study and follow-up for 1-year period. the association between total and free serum levels of p-cresol and the glomerular filtration rate were evaluated in ckd patients. the p-cresol level was correlated with other many inflammatory markers (white blood cell counts, ferritin, hs-crp, leptin) and also with the hospitalization rate secondary to cardiovascular and infectious event. the renal outcome and all-cause mortality was assessed. determination of this relationship can help to establish an accurate marker for early detection of ckd and also its prognostic role in ckd patients.


Eligibility criteria:
inclusion criteria: * all ckd patients attended at out-patient department of nephrology were included for analysis. * the inclusion criteria were adults aged \> 18 y/o or \< 80 y/o * estimated gfr or ccr \< 60 ml/min * no spontaneous renal improvement or progression in past 3 months. exclusion criteria: * recent cardiovascular disease (coronary artery disease, myocardial ischemia, cerebrovascular disease or peripheral artery disease) in past 3 months * recent infections requiring admission in past 3 months * uncontrolled hypertension * serum albumin level \< 2.5mg/dl * unwilling to participate in the trial.

Keywords: p-cresol indoxyl sulfate chronic kidney disease outcome