Abstract:

【Abstract】Objective To investigate the impact of indoxyl sulfate (IS) on cardiovascular events and hospitalizations in patients undergoing maintenance hemodialysis (MHD). Methods Patients receiving MHD at the First Affiliated Hospital of Dalian Medical University between January 1 and May 31, 2022 were enrolled. Based on the median IS level of 43.00 mg/L (interquartile range 29.98～60.72mg/L), participants were divided into a low-IS group (＜43 mg/L) and a high-IS group (≥43 mg/L). Inter-group differences were compared. Patients were followed up until May 31, 2025, during which cardiovascular events and hospitalizations were recorded. Logistic regression analysis was performed to identify associated factors. Results A total of 137 patients were included, with 68 in the low-IS group and 69 in the high-IS group. Significant inter-group differences were observed in urea clearance index (Z=2.547, P=0.011), diabetes prevalence (χ2 =6.635, P= 0.010), residual renal function (χ2 =4.109, P=0.043), systolic blood pressure (Z=2.565, P=0.010), body mass index (t=3.311, P=0.001), high-density lipoprotein cholesterol (Z=1.929, P=0.05), fasting glucose (Z=3.859, P＜0.001), triglyceride-glucose index (Z=2.680, P=0.007), N-terminal pro-brain natriuretic peptide (Z=2.833, P=0.005), IS level (Z=10.100, P＜0.001), left ventricular end-diastolic diameter (t=3.585, P＜0.001), left atrial diameter (Z=3.585, P=0.021), interventricular septal thickness (Z=4.092, P＜0.001), left ventricular posterior wall thickness (Z=4.122, P＜0.001), left ventricular mass index (t=5.480, P＜0.001), left ventricular ejection fraction (Z=2.517, P=0.012), and global longitudinal strain of the left ventricle (t=-7.470, P＜0.001). Multivariate logistic regression analysis identified age (OR=1.060, 95% CI: 1.004～1.118, P=0.036), hypertension (OR=3.877, 95% CI:1.180～12.737, P=0.026), triglyceride-glucose index (OR=6.359, 95% CI: 1.312～ 30.815, P=0.022), and IS level (OR=1.066, 95% CI: 1.025～1.108, P=0.001) as independent risk factors for cardiovascular events in MHD patients; while diabetes (OR=6.520, 95% CI:1.673～25.408, P=0.007) and IS level (OR=1.059, 95% CI: 1.021～1.097, P=0.002) were identified as independent risk factors for hospitalization. Conclusion IS level is an independent risk factor for both cardiovascular events and hospitalization in MHD patients. 

Key words: Hemodialysis, Indoxyl sulfate, Cardiovascular events, Hospitalizatio