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Association of Serum Indoxyl Sulfate Levels with Skeletal Muscle Mass and Strength in Chronic Hemodialysis Patients: A 2-year Longitudinal Analysis

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Abstract

Sarcopenia is highly prevalent in patients undergoing chronic hemodialysis (HD). This study investigated the relationship among serum indoxyl sulfate (IS) levels, muscle mass, and strength in HD patients. A total of 108 HD patients were enrolled. Skeletal muscle mass and handgrip strength (HGS) were assessed, using bioimpedance analysis and a hand-held dynamometer, respectively. Skeletal muscle index (SMI) was defined as skeletal muscle mass/height2 (kg/m2). Serum IS, p-cresol sulfate (PCS), and trimethylamine N-oxide (TMAO) levels were determined using liquid chromatography–mass spectrometry. Patients were classified into two groups based on median serum IS values. HGS measurement was repeated after 2 years. Patients in the high IS group had longer HD duration and higher serum TMAO levels than those in the low IS group. Log-normalized IS level was negatively correlated with SMI (r = − 0.227; p = 0.018), but PCS and TMAO levels were not. Among 78 patients who completed 2-year follow-up, those in the high IS group (n = 41) showed greater absolute (− 2.48 kg versus − 0.25 kg, p = 0.035) and relative HGS loss (− 9.1% versus 1.4%, p = 0.036) than those in the low IS group, after adjustment for potential confounders. Indoxyl sulfate (IS) may play a significant role in uremic sarcopenia. Further large-scale studies are needed to confirm our preliminary findings.

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Funding

This study was supported by a Grant from Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan (TCRD107-56).

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Authors and Affiliations

  1. Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97010, Taiwan

    Yu-Li Lin, Yu-Hsien Lai, Chih-Hsien Wang, Chiu-Huang Kuo & Bang-Gee Hsu

  2. School of Medicine, Tzu Chi University, Hualien, 97010, Taiwan

    Yu-Li Lin & Bang-Gee Hsu

  3. Institute of Pharmacology and Toxicology, Tzu Chi University, Hualien, 97010, Taiwan

    Chin-Hung Liu

  4. Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan

    Hung-Hsiang Liou

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  1. Yu-Li Lin
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Contributions

Conceptualization, Y-LL and B-GH; methodology, Y-LL and B-GH; formal analysis, Y-LL and C-HL; investigation, Y-HL, C-HW, and C-HK; data curation, Y-HL, C-HW, and C-HK; funding acquisition, C-HL and Y-HL; writing—original draft preparation, Y-LL; writing—review and editing, Y-LL, C-HL, H-HL and B-GH; supervision, H-HL and B-GH.

Corresponding authors

Correspondence to Hung-Hsiang Liou or Bang-Gee Hsu.

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Conflict of interest

Yu-Li Lin, Chin-Hung Liu, Yu-Hsien Lai, Chih-Hsien Wang, Chiu-Huang Kuo, Hung-Hsiang Liou and Bang-Gee Su declare no conflict of interest.

Human and animal rights, Informed consent

This study was approved by the Institutional Review Board of Tzu Chi Hospital (IRB104-84-B), and all patients gave written informed consent in accordance with the general recommendations of the Declaration of Helsinki.

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Lin, YL., Liu, CH., Lai, YH. et al. Association of Serum Indoxyl Sulfate Levels with Skeletal Muscle Mass and Strength in Chronic Hemodialysis Patients: A 2-year Longitudinal Analysis. Calcif Tissue Int 107, 257–265 (2020). https://doi.org/10.1007/s00223-020-00719-x

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  • DOI: https://doi.org/10.1007/s00223-020-00719-x

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