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. 2010 Apr;25(4):1183-91.
doi: 10.1093/ndt/gfp592. Epub 2009 Nov 13.

Free p-cresylsulphate is a predictor of mortality in patients at different stages of chronic kidney disease

Sophie Liabeuf  1 , Daniela V Barreto, Fellype C Barreto, Natalie Meert, Griet Glorieux, Eva Schepers, Mohammed Temmar, Gabriel Choukroun, Raymond Vanholder, Ziad A Massy; European Uraemic Toxin Work Group (EUTox)
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Free p-cresylsulphate is a predictor of mortality in patients at different stages of chronic kidney disease

Sophie Liabeuf et al. Nephrol Dial Transplant. 2010 Apr.

Abstract

Background: Uraemic toxins are considered to be emerging mortality risk factors in chronic kidney disease (CKD) patients. p-Cresol (a prototype protein-bound uraemic retention solute) has been shown to exert toxic effects in vitro. Recently, it has been demonstrated that p-cresol is present in plasma as its sulphate conjugate, p-cresylsulphate. The present study evaluated the distribution of free and total p-cresylsulphate and sought to determine whether these parameters were associated with vascular calcification, arterial stiffness and mortality risk in a cohort of CKD patients.

Methods: One hundred and thirty-nine patients (mean +/- SD age: 67 +/- 12; males: 60%) at different stages of CKD (8% at Stage 2, 26.5% at Stage 3, 26.5% at Stage 4, 7% at Stage 5 and 32% at Stage 5D) were enrolled in this study.

Results: Baseline total and free p-cresylsulphate presented an inverse relationship with renal function and were significantly associated with vascular calcification. During the study period (mean follow-up period: 779 +/- 185 days), 38 patients died [including 22 from cardiovascular (CV) causes]. In crude survival analyses, free (but not total) p-cresylsulphate was shown to be a predictor of overall and CV death. Higher free p-cresylsulphate levels (>0.051 mg/100 mL; median) were associated with mortality independently of well-known predictors of survival such as age, vascular calcification, anaemia and inflammation.

Conclusions: Serum levels of free and total p-cresylsulphate (the main in vivo circulating metabolites of p-cresol) were elevated in later CKD stages. However, only free p-cresylsulphate seems to be a predictor of survival in CKD.

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