Associations among chronic kidney disease, high total p-cresylsulfate and left ventricular systolic dysfunction

作者：Lu Li Fen; Tang Wei Hua; Hsu Chia Chang; Tsai I Ting; Hung Wei Chin; Yu Teng Hung; Wu Cheng Ching; Chung Fu Mei; Lu Yung Chuan; Lee Yau Jiunn; Wang Chao Ping^*

来源：Clinica Chimica Acta, 2016, 457: 63-68.

DOI：10.1016/j.cca.2016.03.012

• Chronic kidney disease
• Total p-cresylsulfate
• Estimated glomerular filtration rate
• Left ventricular systolic dysfunction

Background: A significant number of patients with chronic kidney disease (CKD) have cardiac abnormalities, and left ventricular systolic dysLVSD) is a common manifestation. p-Cresylsulfate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. Furthermore, the associations among serum total PCS, major adverse cardiovascular events, all-cause mortality, and QTc prolongation have also been found in previous studies. We thus investigated the association of total PCS and CKD with LVSD in the clinical setting.
Methods: We included 403 consecutive patients with stable angina. To evaluate LV function, all patients underwent echocardiography. To measure the serum total PCS concentrations and estimated glomerular filtration rate (eGFR), blood samples were obtained.
Results: Multiple regression analysis showed that left atrium diameter, left ventricular mass index, end diastolic interventricular septal thickness, left ventricular end-systolic diameter, left ventricular end-systolic volume, stroke volume, left ventricular end-systolic volume index, left ventricular ejection fraction (LVEF), and the inter ventricular septum/posterior wall of the left ventricle were independently associated with total PCS (all p < 0.05). In addition, a significantly decreased LVEF was present in patients with lower and higher serum total PCS and with CKD, and with higher serum total PCS and without CKD than from those with lower serum total PCS concentrations and without CKD (p = 0.004). In the multivariate logistic regression analysis, when patients without CKD and lower PCS were used as reference group, patients with the higher total PCS concentration and without CKD had an odds ratio of 3.59 for the risk of LVSD, the lower total PCS concentration and with CKD had an odds ratio of 3.89 for the risk of LVSD, and the higher total PCS concentration and with CKD had an odds ratio of 4.04 for the risk of LVSD (p = 0.039, p = 0.038, and p = 0.020, respectively).
Conclusions: High serum concentrations of total PCS or CKD, or both, represent an increased risk of impaired LV systolic function in stable angina patients.

• 出版日期2016-6-1