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The following is a summary of “Association between serum total indoxyl sulfate, intraperitoneal inflammation, and peritoneal dialysis technique failure: a 3-year prospective cohort study,” published in the December 2024 issue of Nephrology by Stepanova et al. 

The role of protein-bound uremic toxins, particularly indoxyl sulfate (IS), in peritoneal dialysis (PD) complications is unclear. 

Researchers conducted a retrospective study to explore the relationship between serum total IS (tIS) levels, proinflammatory cytokines in serum and peritoneal dialysis effluent (PDE), and PD technique survival.  

They followed 84 patients over 3 years and stratified them into low-tIS (<22.6 µmol/L) and high-tIS (≥22.6 µmol/L) groups based on the median serum tIS concentration. Logistic regression, Kaplan-Meier, receiver operating characteristic, and Cox regression analyses were used to assess associations between tIS levels, cytokine concentrations (IL-6, MCP-1, TNF-α), and PD technique failure. 

The results showed that patients in the high-tIS group were older and had a higher prevalence of diabetes, more PD-related peritonitis, elevated diastolic blood pressure, and lower HDL cholesterol. They also had higher peritoneal transport characteristics, lower dialysis adequacy, and reduced peritoneal creatinine clearance. Elevated tIS levels correlated with higher PDE cytokine levels but not serum cytokine levels. Serum tIS levels ≥50 µmol/L predicted PD technique failure with 70.4% sensitivity and 87.9% specificity (P < 0.0001). The association remained significant after adjusting for confounders (HR 2.9, 95% CI 1.13; 8.21). 

Investigators demonstrated a link between elevated tIS levels, peritoneal inflammation, and an increased risk of PD technique failure. Monitoring tIS levels in patients with PD could aid in risk assessment and personalized management to improve long-term outcomes. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03935-x