The Association of Uremic Toxins and Inflammation in Hemodialysis Patients

Background Cardiovascular disease is the leading cause of mortality in hemodialysis patients and is associated with chronic inflammation. Elevation of uremic toxins, particular protein-bound uremic toxins, is a possible cause of hyper-inflammation in hemodialysis patients. But the association between uremic toxins and inflammatory markers in hemodialysis is still unclear. Methods We conducted a cross-sectional study to evaluate the association of the serum uremic toxins and inflammatory markers in hemodialysis patients. Results The uremic toxins were not associated with inflammatory markers- including high sensitivity C-reactive protein, IL(Interleukin) -1β, IL-6, tumor necrosis factor-α. In multiple linear regression, serum levels of total p -cresol sulfate ( P CS) were independently significantly associated with serum total indoxyl sulfate (IS) (standardized coefficient: 0.274, p <0.001), and co-morbidity of diabetes mellitus (DM) (standardized coefficient: 0.342, p <0.001) and coronary artery disease (CAD) (standardized coefficient: 0.128, p  = 0.043). The serum total P CS levels in hemodialysis with co-morbidity of DM and CAD were significantly higher than those without co-morbidity of DM and CAD (34.10±23.44 vs. 16.36±13.06 mg/L, p <0.001). Serum levels of total IS was independently significantly associated with serum creatinine (standardized coefficient: 0.285, p <0.001), total P CS (standardized coefficient: 0.239, p  = 0.001), and synthetic membrane dialysis (standardized coefficient: 0.139, p  = 0.046). Conclusion The study showed that serum levels of total PCS and IS were not associated with pro-inflammatory markers in hemodialysis patients. Besides, serum levels of total P CS were independently positively significantly associated with co-morbidity of CAD and DM.