p-Cresyl sulfate predicts clinical outcomes in sustained peritoneal dialysis: a 5-year follow-up cohort study and meta-analysis

Abstract

Background The impact of p -cresyl sulfate (PCS) and indoxyl sulfate (IS) on the prognosis of patients with uremia remains controversial. We performed a prospective study on peritoneal dialysis (PD) to investigate the relationship between PCS or IS levels with clinical outcomes. Methods This prospective cohort study investigated the association of serum PCS and IS with clinical outcomes in patients undertaking PD. We performed a correlations analysis to explore the influencing factors of PCS an IS. Meta-analysis was conducted to objectively evaluate the prognostic effects of PCS and IS on different stages of CKD patients. Results A total of 127 patients were enrolled consecutively and followed with an average period of 51.3 months. Multivariate Cox regression showed that serum total PCS not only contributed to the occurrence of PD failure event (HR: 1.05, 95% CI = 1.02 to 1.07, p < 0.001), but also increased the risk of cardiovascular event (HR: 1.08, 95% CI = 1.04 to 1.13, p < 0.001) and PD-associated peritonitis (HR: 1.04, 95% CI = 1.02 to 1.08, p = 0.001). Dividing the total PCS level by 18.99 mg/L, which was calculated from the best cutoff value of the ROC curve, patients with total PCS higher than 18.99 mg/L had worse prognosis. Meta-analysis confirmed its value in cardiovascular event in PD. Conclusion The serum total PCS concentration was a detrimental factor for higher PD failure event, cardiovascular event, and PD-associated peritonitis. It could be used as an innovative marker in predicting poor clinical outcome in PD.

Association between serum total indoxyl sulfate, intraperitoneal inflammation, and peritoneal dialysis technique failure: a 3-year prospective cohort study

“…Additionally, serum tIS concentrations showed signi cant correlations with other PD-related parameters, including peritoneal, renal, and total weekly Kt/V, as well as peritoneal weekly CrCl, suggesting that tIS levels could serve as a marker for PD adequacy and peritoneal membrane function. These ndings align with previously published data demonstrating the association of tIS with diuresis, weekly Kt/V, peritoneal CrCl, and the D/P creatinine ratio [4,5,16,17]. However, our study is the rst to establish a direct correlation between tIS concentrations and the occurrence of peritonitis.…”

“…Our study corroborates the ndings of Lin et al, recognizing that serum tIS is a signi cant and independent risk factor for 5-year PD technique failure, irrespective of various patient and dialysis characteristics [24]. In contrast, Chen et al's results did not identify tIS as a notable risk factor, which highlights a discrepancy in the literature [5]. It should be noted that the inclusion of PDE cytokines in our Cox regression analysis led to a reduction in the predictive signi cance of tIS.…”

“…Despite its widespread adoption and inherent advantages, the challenge of technique failure, often leading to a transition to hemodialysis (HD), remains a prominent concern in PD treatment [2,3]. Among the multifaceted factors contributing to the intricacies of PD technique failure, recent attention has been directed toward the role of uremic toxins, with a speci c focus on protein-bound uremic toxins [4,5].…”