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1 University Hospital Gent, Department of Internal Medicine, Renal Division, De Pintelaan 185, B-9000 Ghent, Belgium.
2 Institut National de la Santé et de la Recherche Médicale, EMI 0019, Faculté de Pharmacie, Université de la Méditerranée, 13005 Marseille, France.
aAuthor for correspondence. Fax 32-9-2404599; e-mail rita.desmet{at}rug.ac.be.
Background: Uremic syndrome is the consequence of the retention of solutes usually cleared by the healthy kidneys. p-Cresol can be considered a prototypic protein-bound uremic toxin. It is conceivable, analogous with drugs, that the non-protein-bound fraction of p-cresol exerts toxicity. This aspect had never been evaluated, nor have the factors influencing the free fraction of p-cresol.
Methods: In a transsectional study we evaluated the relationship between prehemodialysis free p-cresol and the ratio of free to total p-cresol (F:T) to clinical and biological factors in 44 chronic renal failure patients. The evolution of free p-cresol was assessed prospectively in 12 patients showing a change in serum albumin of at least 5 g/L over time. Hospitalization days attributable to infection and the free p-cresol concentrations were noted over a 1-year period. The impact of free p-cresol in vitro on leukocyte functional capacity was evaluated by chemiluminescence.
Results: We observed a correlation between total and free p-cresol (r = 0.84; P <0.001). In the multivariate analyses, free p-cresol and F:T showed a negative correlation with albumin. A shift from normal serum albumin to hypoalbumininemia in 12 patients led to an increase in free p-cresol from 5.9 ± 3.2 to 8.2 ± 4.5 µmol/L (P <0.05; 0.64 ± 0.35 to 0.89 ± 0.49 mg/L). Free p-cresol (P <0.05) was higher in the patients hospitalized for infectious disease. In vitro, free p-cresol was higher in a 25 g/L than in a 50 g/L albumin solution (P <0.05). Leukocyte chemiluminescence production was more inhibited in the low albumin (high free p-cresol) solution (28% ± 6% vs 21% ± 8%; P <0.05).
Conclusions: Hypoalbuminemia and total p-cresol increase the free fraction of p-cresol. Patients hospitalized for infections have higher free p-cresol. In vitro, high free p-cresol has a negative impact on leukocyte chemiluminescence production. These data demonstrate the toxicity of free p-cresol.
The following articles in journals at HighWire Press have cited this article:
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  R. Vanholder, S. V. Laecke, F. Verbeke, G. Glorieux, and W. V. Biesen Uraemic toxins and cardiovascular disease: in vitro research versus clinical outcome studies NDT Plus, February 1, 2008; 1(1): 2 - 10. [Full Text] [PDF]
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A. W. Martinez, N. S. Recht, T. H. Hostetter, and T. W. Meyer Removal of P-Cresol Sulfate by Hemodialysis J. Am. Soc. Nephrol., November 1, 2005; 16(11): 3430 - 3436. [Abstract] [Full Text] [PDF]
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R. A. Ward Protein-Leaking Membranes for Hemodialysis: A New Class of Membranes in Search of an Application? J. Am. Soc. Nephrol., August 1, 2005; 16(8): 2421 - 2430. [Abstract] [Full Text] [PDF]
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