Association between indoxyl sulfate and bone histomorphometry in pre-dialysis chronic kidney disease patients

• Published in: Brazilian Journal of Nephrology Vol. 36; no. 3; pp. 289 - 296
• Main Authors: Barreto, Fellype Carvalho, Barreto, Daniela Veit, Canziani, Maria Eugênia Fernandes, Tomiyama, Cristianne, Higa, Andrea, Mozar, Anaïs, Glorieux, Griet, Vanholder, Raymond, Massy, Ziad, de Carvalho, Aluizio Barbosa
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Nefrologia 01-09-2014
• Subjects: Bone and Bones - anatomy & histology; Cross-Sectional Studies; Female; Humans; Indican - blood; indoxil sulfato; insuficiência renal crônica; Male; Middle Aged; osteodistrofia renal; Renal Dialysis; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - pathology; uremia
• ISSN: 0101-2800; 2175-8239; 2175-8239
• DOI: 10.5935/0101-2800.20140042

Experimental studies have suggested that indoxyl sulfate (IS), a protein-bound uremic toxin, may be involved in the development of renal osteodystrophy.
evaluate the association between IS levels and biochemical parameters related to mineral metabolism and bone histomorphometry in a cohort of pre-dialysis chronic kidney disease (CKD) patients.
This is a post-hoc analysis of an observational study evaluating the association between coronary calcification and bone biopsy findings in 49 patients (age: 52 ± 10 years; 67% male; estimated glomerular filtration rate: 36 ± 17 ml/min). Serum levels of IS were measured.
Patients at CKD stages 2 and 3 presented remarkably low bone formation rate. Patients at CKD stages 4 and 5 presented significantly higher osteoid volume, osteoblast and osteoclast surface, bone fibrosis volume and bone formation rate and a lower mineralization lag time than CKD stage 2 and 3 patients. We observed a positive association between IS levels on one hand and the bone formation rate, osteoid volume, osteoblast surface and bone fibrosis volume on the other. Multivariate regression models confirmed that the associations between IS levels and osteoblast surface and bone fibrosis volume were both independent of demographic and biochemical characteristics of the study population. A similar trend was observed for the bone formation rate.
Our findings demonstrated that IS is positively associated with bone formation rate in pre-dialysis CKD patients.