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BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Acute Kidney Injury | Research article

Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study

Authors: Wenji Wang, Guihua Hao, Yu Pan, Shuai Ma, Tianye Yang, Peng Shi, Qiuyu Zhu, Yingxin Xie, Shaojun Ma, Qi Zhang, Hong Ruan, Feng Ding

Published in: BMC Nephrology | Issue 1/2019

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Abstract

Background

Protein-bound uremic toxins are associated with poor outcomes in patients with chronic kidney disease. The aim of this study is to investigate the relationship between indoxyl sulfate (IS), a protein-bound solute, and 90-day mortality in patients with acute kidney injury.

Methods

Adults with hospital-acquired AKI (HA-AKI) were enrolled in this prospective cohort study between 2014 and 2015, according to the KDIGO creatinine criteria. The primary end point was all-cause death during follow-up.

Results

The mean serum IS level in patients with HA-AKI was 2.74 ± 0.75 μg/ml, which was higher than that in healthy subjects (1.73 ± 0.11 μg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 μg/ml, P = 0.016) but was lower than that in patients with chronic kidney disease (3.07 ± 0.31 μg/ml, P < 0.001). Furthermore, serum IS levels (2.83 ± 0.55 μg/ml) remained elevated in patients with HA-AKI on the seventh day after AKI diagnosis. Patients with HA-AKI were divided into the following two groups according to the median serum IS level: the low-IS group and the high-IS group. A total of 94 (35.9%) patient deaths occurred within 90 days, including 76 (29.0%) in the low-IS group and 112 (42.7%) in the high-IS group (P = 0.019). Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-day survival (log-rank P = 0.007), and Cox regression analysis showed that an IS level ≥ 2.74 μg/ml was significantly associated with a 2.0-fold increased risk of death (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.76 to 4.86; P < 0.001) compared with an IS level < 2.74 μg/ml.

Conclusions

Serum IS levels were significantly elevated in patients with HA-AKI compared to those in healthy subjects and critically ill patients and were associated with a worse prognosis of HA-AKI.

Trial registration

www.​clinicaltrials.​gov NCT 00953992. Registered 6 August 2009.
Appendix
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Metadata
Title
Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study
Authors
Wenji Wang
Guihua Hao
Yu Pan
Shuai Ma
Tianye Yang
Peng Shi
Qiuyu Zhu
Yingxin Xie
Shaojun Ma
Qi Zhang
Hong Ruan
Feng Ding
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-019-1238-9

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