Evolution of protein-bound uremic toxins indoxyl sulphate and p-cresyl sulphate in acute kidney injury

  • Laurens VeldemanEmail author
  • Jill Vanmassenhove
  • Wim Van Biesen
  • Ziad A. Massy
  • Sophie Liabeuf
  • Griet Glorieux
  • Raymond Vanholder
Nephrology - Original Paper



There is a gradual increase in serum concentrations of protein-bound colon-derived uremic toxins indoxyl sulphate (IxS) and p-cresyl sulphate (pCS) as chronic kidney disease (CKD) progresses. In acute kidney injury (AKI), up till now, the retention pattern has not been studied.


In this study, 194 adult patients admitted with sepsis to the intensive care unit were included. IxS, pCS and serum creatinine (sCrea) were quantified at inclusion (D0) and at day 4, unless follow-up ended earlier (Dend).


Serum levels of sCrea (P < 0.001), IxS (P < 0.001) and pCS (P < 0.05) were higher in patients with AKI according to RIFLE classification at D0. In contrast with sCrea, IxS and pCS levels only increased from stage I (IxS) and F (pCS) on. When grouped according to evolution in RIFLE class from D0 to Dend, all solute concentrations were higher (P < 0.001) in the group with unfavourable evolution. In this group, there was a marked rise in sCrea (P < 0.001), a moderate one for pCS (P < 0.05), but no change for IxS (P = 0.112). There was a decrease (P < 0.001) of all solute concentrations in the group with favourable evolution. Comparing AKI with CKD patients matched for sCrea, total levels of both IxS and pCS were higher (P < 0.01) in patients with CKD.


Although concentrations of IxS and pCS both tend to rise in sepsis patients with AKI, their evolution does not conform with that of sCrea. For the same level of sCrea, IxS and pCS concentrations are lower in AKI compared with CKD.


AKI Sepsis Uremic toxins Indoxyl sulphate p-Cresyl sulphate 



The authors thank the technicians of the Ghent Nephrology Laboratory for the UPLC quantification of the uremic solutes.

Author contributions

LV conducted the statistical analysis and wrote the first draft. JV included the patients, collected the samples and the demographic data. RV and GG designed the study, helped writing the draft and critically reviewed it. SL and ZAM collected and provided the samples of CKD patients. JV, WVB, ZAM and SL revised the paper.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

Supplementary material

11255_2018_2056_MOESM1_ESM.docx (69 kb)
Supplementary material 1 (DOCX 69 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Nephrology DivisionGhent University HospitalGhentBelgium
  2. 2.Nephrology Division, Ambroise Paré HospitalAPHP, and Paris Ile de France West (UVSQ) UniversityBoulogne BillancourtFrance
  3. 3.Inserm U1018 Team5UVSQ, University ParisSaclay VillejuifFrance
  4. 4.Division of Clinical PharmacologyAmiens University HospitalAmiensFrance

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