Journal
CLINICAL KIDNEY JOURNAL
Volume 15, Issue 4, Pages 798-807Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ckj/sfab262
Keywords
CKD; elderly; symptoms; uremic toxins
Categories
Funding
- European Renal Association
- Swedish Medical Association
- Stockholm County Council ALF Medicine and Center for Innovative Research
- Italian Society of Nephrology
- Dutch Kidney Foundation [SB 142]
- Young Investigators grant in Germany
- National Institute for Health Research in the UK
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This study found that only a limited number of uremic toxins were associated with symptoms in patients with stage 4/5 CKD. Other uremic toxins, uremia-related factors, or unexplored psychosocial factors might contribute to symptom burden.
Background Patients with stage 4/5 chronic kidney disease (CKD) suffer from various symptoms. The retention of uremic solutes is thought to be associated with those symptoms. However, there are relatively few rigorous studies on the potential links between uremic toxins and symptoms in patients with CKD. Methods The EQUAL study is an ongoing observational cohort study of non-dialyzed patients with stage 4/5 CKD. EQUAL patients from Germany, Poland, Sweden and the UK were included in the present study (n = 795). Data and symptom self-report questionnaires were collected between April 2012 and September 2020. Baseline uric acid and parathyroid hormone and 10 uremic toxins were quantified. We tested the association between uremic toxins and symptoms and adjusted P-values for multiple testing. Results Symptoms were more frequent in women than in men with stage 4/5 CKD, while levels of various uremic toxins were higher in men. Only trimethylamine N-oxide (TMAO; positive association with fatigue), p-cresyl sulfate (PCS) with constipation and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (negative association with shortness of breath) demonstrated moderately strong associations with symptoms in adjusted analyses. The association of phenylacetylglutamine with shortness of breath was consistent in both sexes, although it only reached statistical significance in the full population. In contrast, TMAO (fatigue) and PCS and phenylacetylglutamine (constipation) were only associated with symptoms in men, who presented higher serum levels than women. Conclusion Only a limited number of toxins were associated with symptoms in persons with stage 4/5 CKD. Other uremic toxins, uremia-related factors or psychosocial factors not yet explored might contribute to symptom burden.
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