P-cresol: Correlation With Glomerular Filtration Rate and Outcome in Chronic Kidney Disease
Condition: Risk Factors; Renal Progression; Death
MeSH terms: Disease Progression
Study type: Observational

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.
    


Intervention name(s): there are no interventions currently listed for this study
Intervention type(s): Other
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        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.
      
Biospecimen description: 
      Serum level of p-cresol and indoxyl sulfate
    
Keywords: p-cresol; indoxyl sulfate; chronic kidney disease; outcome