The relationship between serum indoxyl sulfate and the renal function after catheter ablation of atrial fibrillation in patients with mild renal dysfunction
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Indoxyl sulfate (IS), a protein-bound uremic toxin, induces renal disorders and atrial fibrillation (AF). It is well known that renal dysfunction is a risk factor for AF and radiofrequency catheter ablation (RFCA) improves the renal function. However, the improvement in the renal function after RFCA in patients with early stage chronic kidney disease (CKD) and the serial changes in the IS level have not been fully elucidated. This study aimed to investigate whether IS affects the improvement in the renal function. A total of 91 consecutive patients with mild kidney dysfunction (CKD stage I–II) who underwent RFCA and maintained sinus rhythm were prospectively enrolled. The plasma IS level and estimated glomerular filtration rate (eGFR) were determined before, 3 months, and 1 year after RFCA. The patients were divided according to the IS quartiles (Q1–4; < 0.4, 0.4–0.7, 0.7–1.2, and > 1.2 μg/ml). There was no significant difference in the eGFR among the IS quartiles. A significantly higher eGFR improvement rate was obtained for IS-Q4 than the other quartiles (p = 0.039). The IS-Q4 IS level significantly decreased at 1 year after RFCA (1.8 ± 0.8 to 1.2 ± 0.7 μg/ml, p < 0.01). The multivariable logistic model revealed that a high-IS level (IS-Q4) was an independent predictor of an eGFR improvement (OR 3.33; 95% CI 1.16–9.59; p = 0.026). A high-IS level reduction after RFCA improved the renal function in AF patients with mild kidney dysfunction.
KeywordsIndoxyl sulfate Atrial fibrillation Renal function Catheter ablation
This manuscript was supported in part by Grants-in-Aid (15K09103 and 16K01433 to T.I.) for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan. We thank Mr. John Martin for his help with the preparation of the manuscript and Mr. Osuka for his help in supporting this present study.
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Conflict of interest
This research received no grants from any funding agencies in the public, commercial, or not-for-profit sectors. The authors declare that there is no conflict of interest.
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