Association between serum p-cresyl sulfate levels and cardiac valve calcification as well as prognosis in maintenance hemodialysis patients

Abstract Objective Cardiac valve calcification is a common complication in patients undergoing maintenance hemodialysis, and is closely linked to adverse clinical outcomes. P -cresyl sulfate, a typical protein-bound uremic toxin, has been implicated in the pathogenesis of vascular and valvular calcification. However, the relationships of p -cresyl sulfate with cardiac valve calcification and its prognostic value in maintenance hemodialysis patients remain poorly elucidated. This study aimed to investigate the correlations among serum p -cresyl sulfate level, cardiac valve calcification and clinical prognosis in this patient population. Methods A total of 79 consecutive patients receiving regular maintenance hemodialysis were recruited in this single-center observational cohort study and divided into the cardiac valve calcification group ( n = 25) and non-cardiac valve calcification group ( n = 54) according to transthoracic echocardiographic results. All patients were followed prospectively for 12 months, with all-cause mortality and major adverse cardiovascular events recorded as predefined endpoints. Logistic regression analysis was performed to identify independent risk factors for cardiac valve calcification and adverse cardiovascular outcomes. Results Compared with the non-cardiac valve calcification group, patients in the cardiac valve calcification group were significantly older (67.20 vs. 55.94 years, P < 0.001) and had higher serum p -cresyl sulfate level (466.04 vs. 400.65 µg/mL, P = 0.006). Multivariate logistic regression analysis demonstrated that age [Odds Ratio = 1.083, 95% CI 1.027–1.142, P = 0.003] and serum p -cresyl sulfate level [Odds Ratio = 1.007, 95% CI 1.001–1.013, P = 0.019] were independent risk factors for cardiac valve calcification. The area under the Receiver Operating Characteristic curve for p -cresyl sulfate in predicting cardiac valve calcification was 0.713 (95% CI 0.575–0.850, P = 0.002). Elevated p -cresyl sulfate level was not significantly associated with all-cause mortality, but was identified as an independent risk factor for major adverse cardiovascular events [Odds Ratio = 11.800, 95% CI 2.832–49.163, P = 0.001]. Conclusion Elevated serum p -cresyl sulfate level was independently associated with cardiac valve calcification and an increased risk of cardiovascular events in maintenance hemodialysis patients. Given the limited sample size and moderate discriminative ability (AUC = 0.713), p -cresyl sulfate can only be regarded as a candidate biomarker pending further external validation rather than a clinically validated marker for cardiovascular risk stratification in this patient population.