P-cresol: Correlation With Glomerular Filtration Rate and Outcome in Chronic Kidney Disease

Study Overview
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Brief Summary
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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.

Conditions
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Risk Factors, Renal Progression, Death

Intervention / Treatment
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* Other: there are no interventions currently listed for this study


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| 2<br>CKD patients with normal p-cresol | Other: there are no interventions currently listed for this study<br> <br> |
| 3<br>CKD patient with normal indoxyl sulfate | Other: there are no interventions currently listed for this study<br> <br> |
| 4<br>CKD patients with high indoxyl sulfate | Other: there are no interventions currently listed for this study<br> <br> |
| 1<br>CKD patients with high p cresol | Other: there are no interventions currently listed for this study<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| end stage renal disease, reduction of eGFR by 50% and death |  | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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p-cresol, indoxyl sulfate, chronic kidney disease, outcome