p-Cresyl sulphate and indoxyl sulphate predict progression of chronic kidney disease

Nephrol Dial Transplant. 2011 Mar;26(3):938-47. doi: 10.1093/ndt/gfq580. Epub 2010 Sep 29.


Background: Indoxyl sulphate (IS) and p-cresyl sulphate (PCS) are uraemic toxins that have similar protein binding, dialytic clearance and proinflammatory features. However, only a few prospective studies have evaluated possible associations between these two retained solutes and renal disease progression in chronic kidney disease (CKD) patients.

Methods: This prospective observational study evaluated independent associations between serum total IS and PCS with renal progression in a selected cohort of patients having different stages of CKD. Baseline PCS and IS were correlated with renal progression [defined as decrements in estimated glomerular filtration rate (eGFR) > 50% from baseline or progression to end-stage renal disease (ESRD)] and death during a follow-up period of 24 months.

Results: Of 268 patients, 35 (13.1%) had renal progression and 14 (5.2%) died after a mean follow-up of 21 ± 3 months. Univariate Cox regression analysis followed by multivariate analysis showed that high-serum PCS levels were associated with renal progression and all-cause mortality independent of age, gender, diabetes status, albumin levels, serum IS, serum creatinine, Ca × P product, intact parathyroid hormone, haemoglobin or high-sensitivity C-reactive protein level. Serum IS was only associated with renal progression; however, the predictive power of serum IS was weakened when serum PCS was also present in the analytical model.

Conclusions: In addition to traditional and uraemia-related risk factors such as renal function, serum IS and PCS levels may help in predicting the risk of renal progression in patients having different stages of CKD.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Cohort Studies
  • Creatinine / blood
  • Cresols / blood*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Glomerular Filtration Rate
  • Humans
  • Indican / blood*
  • Kidney Failure, Chronic / blood*
  • Kidney Function Tests
  • Male
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Sulfuric Acid Esters / blood*
  • Survival Rate
  • Uremia / blood*


  • Biomarkers
  • Cresols
  • Sulfuric Acid Esters
  • 4-cresol sulfate
  • Creatinine
  • Indican