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Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease.
Toxins (Basel). 2018 12 05; 10(12)T

Abstract

Although the relationship between protein-bound uremic toxins (PBUTs) and cardiac structure and cardiac mortality in chronic kidney disease (CKD) has been studied in the past, the association between cardiac dysfunction and PBUTs has not yet been studied. We therefore evaluated the association between impaired peak cardiac performance and the serum free and total concentrations of potentially cardiotoxic PBUTs. In a cross-sectional study of 56 male CKD patients (stages 2⁻5 (pre-dialysis)) who were asymptomatic with no known cardiac diseases or diabetes we measured peak cardiac power (CPOmax), aerobic exercise capacity (VO2max), and echocardiographic parameters of cardiac morphology and evaluated their association with PBUTs. The serum total and free concentrations of indoxyl sulfate (IXS), p-cresyl sulfate (PCS), p-cresyl glucuronide, indole acetic acid, and hippuric acid showed significant negative correlation with CPOmax and VO2max. IXS and PCS were independently associated with CPOmax and VO2max even after controlling for eGFR. No correlation between left ventricular mass index (LVMI) and PBUTs was seen. The present study for the first time has demonstrated the association between subclinical cardiac dysfunction in CKD and serum levels of a panel of PBUTs. Further studies are required to evaluate the mechanism of cardiotoxicity of the individual uremic toxins.

Authors+Show Affiliations

Department of Nephrology, Doncaster and Bassetlaw Teaching Hospitals, Doncaster DN2 5LT, UK. shanmugakumar.chinnappa@nhs.net. Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9DA, UK. shanmugakumar.chinnappa@nhs.net.Institute of Epidemiology & Preventive Medicine, College of Public Health, National University of Taiwan, Taipei 100, Taiwan. yukangtu@ntu.edu.tw.Institute of Epidemiology & Preventive Medicine, College of Public Health, National University of Taiwan, Taipei 100, Taiwan. yehyichun@cph.ntu.edu.tw.Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium. griet.glorieux@ugent.be.Department of Nephrology, Ghent University Hospital, 9000 Ghent, Belgium. raymond.vanholder@ugent.be.Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9DA, UK. andrew.mooney2@nhs.net. Department of Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK. andrew.mooney2@nhs.net.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30563136

Citation

Chinnappa, Shanmugakumar, et al. "Association Between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients With Chronic Kidney Disease." Toxins, vol. 10, no. 12, 2018.
Chinnappa S, Tu YK, Yeh YC, et al. Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease. Toxins (Basel). 2018;10(12).
Chinnappa, S., Tu, Y. K., Yeh, Y. C., Glorieux, G., Vanholder, R., & Mooney, A. (2018). Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease. Toxins, 10(12). https://doi.org/10.3390/toxins10120520
Chinnappa S, et al. Association Between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients With Chronic Kidney Disease. Toxins (Basel). 2018 12 5;10(12) PubMed PMID: 30563136.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Protein-Bound Uremic Toxins and Asymptomatic Cardiac Dysfunction in Patients with Chronic Kidney Disease. AU - Chinnappa,Shanmugakumar, AU - Tu,Yu-Kang, AU - Yeh,Yi Chun, AU - Glorieux,Griet, AU - Vanholder,Raymond, AU - Mooney,Andrew, Y1 - 2018/12/05/ PY - 2018/11/15/received PY - 2018/11/26/revised PY - 2018/12/01/accepted PY - 2018/12/20/entrez PY - 2018/12/20/pubmed PY - 2020/2/1/medline KW - aerobic exercise capacity KW - cardiac function KW - cardiac power KW - uremic toxins JF - Toxins JO - Toxins (Basel) VL - 10 IS - 12 N2 - Although the relationship between protein-bound uremic toxins (PBUTs) and cardiac structure and cardiac mortality in chronic kidney disease (CKD) has been studied in the past, the association between cardiac dysfunction and PBUTs has not yet been studied. We therefore evaluated the association between impaired peak cardiac performance and the serum free and total concentrations of potentially cardiotoxic PBUTs. In a cross-sectional study of 56 male CKD patients (stages 2⁻5 (pre-dialysis)) who were asymptomatic with no known cardiac diseases or diabetes we measured peak cardiac power (CPOmax), aerobic exercise capacity (VO2max), and echocardiographic parameters of cardiac morphology and evaluated their association with PBUTs. The serum total and free concentrations of indoxyl sulfate (IXS), p-cresyl sulfate (PCS), p-cresyl glucuronide, indole acetic acid, and hippuric acid showed significant negative correlation with CPOmax and VO2max. IXS and PCS were independently associated with CPOmax and VO2max even after controlling for eGFR. No correlation between left ventricular mass index (LVMI) and PBUTs was seen. The present study for the first time has demonstrated the association between subclinical cardiac dysfunction in CKD and serum levels of a panel of PBUTs. Further studies are required to evaluate the mechanism of cardiotoxicity of the individual uremic toxins. SN - 2072-6651 UR - https://www.unboundmedicine.com/medline/citation/30563136/Association_between_Protein_Bound_Uremic_Toxins_and_Asymptomatic_Cardiac_Dysfunction_in_Patients_with_Chronic_Kidney_Disease_ DB - PRIME DP - Unbound Medicine ER -