Meta-analysis of the associations of p-cresyl sulfate (PCS) and indoxyl sulfate (IS) with cardiovascular events and all-cause mortality in patients with chronic renal failure
Journal
PLoS ONE
Journal Volume
10
Journal Issue
7
Pages
e0132589
Date Issued
2015
Author(s)
Abstract
Background: Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are protein-bound uremic toxins that increase in the sera of patients with chronic kidney disease (CKD), and are not effectively removed by dialysis. The purpose of this meta-analysis was to investigate the relationships of PCS and IS with cardiovascular events and all-cause mortality in patients with CKD stage 3 and above. Methodology/Principle Findings: Medline, Cochrane, and EMBASE databases were searched until January 1, 2014 with combinations of the following keywords: chronic renal failure, end-stage kidney disease, uremic toxin, uremic retention, indoxyl sulfate, p-cresyl sulfate. Inclusion criteria were: 1) Patients with stage 1 to 5 CKD; 2) Prospective study; 3) Randomized controlled trial; 4) English language publication. The associations between serum levels of PCS and IS and the risks of all-cause mortality and cardiovascular events were the primary outcome measures. Of 155 articles initially identified, 10 prospective and one cross-sectional study with a total 1,572 patients were included. Free PCS was significantly associated with all-cause mortality among patients with chronic renal failure (pooled OR = 1.16, 95% CI = 1.03 to 1.30, P = 0.013). An elevated free IS level was also significantly associated with increased risk of all-cause mortality (pooled OR = 1.10, 95% CI = 1.03 to 1.17, P = 0.003). An elevated free PCS level was significantly associated with an increased risk of cardiovascular events among patients with chronic renal failure (pooled OR = 1.28, 95% CI = 1.10 to 1.50, P = 0.002), while free IS was not significantly associated with risk of cardiovascular events (pooled OR = 1.05, 95% CI = 0.98 to 1.13, P = 0.196). Conclusions/Significance: Elevated levels of PCS and IS are associated with increased mortality in patients with CKD, while PCS, but not IS, is associated with an increased risk of cardiovascular events. ? 2015 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
4 cresylsulfate; indican; sulfur derivative; unclassified drug; uremic toxin; 4-cresol sulfate; biological marker; cresol; indican; sulfate; toxin; Article; cardiovascular disease; cardiovascular risk; cause of death; chronic kidney failure; cross-sectional study; disease association; disease severity; end stage renal disease; high risk patient; human; meta analysis (topic); mortality; outcome assessment; prospective study; randomized controlled trial (topic); risk assessment; systematic review; urine retention; blood; Cardiovascular Diseases; chronic kidney failure; complication; meta analysis; mortality; risk factor; uremia; Biomarkers; Cardiovascular Diseases; Cresols; Humans; Indican; Kidney Failure, Chronic; Risk Factors; Sulfuric Acid Esters; Toxins, Biological; Uremia
Publisher
Public Library of Science
Type
journal article