p-Cresol and cardiovascular risk in mild-to-moderate kidney disease.

Abstract

BACKGROUND AND OBJECTIVES:

Cardiovascular disease is highly prevalent in chronic kidney disease. Traditional risk factors are insufficient to explain the high cardiovascular disease prevalence. Free p-cresol serum concentrations, mainly circulating as its derivative p-cresyl sulfate, are associated with cardiovascular disease in hemodialysis patients. It is not known if p-cresol is associated with cardiovascular disease in patients with chronic kidney disease not yet on dialysis.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

In a prospective observational study in 499 patients with mild-to-moderate kidney disease, we examined the multivariate association between p-cresol free serum concentrations and cardiovascular events.

RESULTS:

After a mean follow-up of 33 mo, 62 patients reached the primary end point of fatal or nonfatal cardiovascular events. Higher baseline concentrations of free p-cresol were directly associated with cardiovascular events (univariate hazard ratio [HR] 1.79, P<0.0001). In multivariate analysis, p-cresol remained a predictor of cardiovascular events, independent of GFR and independent of Framingham risk factors (full model, HR 1.39, P=0.04).

CONCLUSIONS:

These findings suggest that p-cresol measurements may help to predict cardiovascular disease risk in renal patients over a wide range of residual renal function, beyond traditional markers of glomerular filtration. Whether p-cresol is a modifiable cardiovascular risk factor in CKD patients remains to be proven.

• Authors: Björn K I Meijers, Kathleen Claes, Bert Bammens, Henriette de Loor, Liesbeth Viaene, Kristin Verbeke, Dirk Kuypers, Yves Vanrenterghem, Pieter Evenepoel
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 5 Issue 7 Pg. 1182-9 (Jul 2010) ISSN: 1555-905X [Electronic] United States
• PMID: 20430946 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Cresols
• 4-cresol

Topics

• Aged
• Belgium
• Biomarkers (blood)
• Cardiovascular Diseases (blood, etiology, mortality, physiopathology)
• Cresols (blood)
• Female
• Glomerular Filtration Rate
• Humans
• Kaplan-Meier Estimate
• Kidney Diseases (blood, complications, mortality, physiopathology)
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Time Factors