cinnamoylglycine and Myocardial-Infarction

The clearance of protein-bound solutes by the proximal tubules is an innate kidney mechanism for removing putative uremic toxins that could exert cardiovascular toxicity in humans. However, potential associations between impaired kidney clearances of secretory solutes and cardiovascular events among patients with chronic kidney disease (CKD) remains uncertain.. A multicenter, prospective, cohort study.. We evaluated 3,407 participants from the Chronic Renal Insufficiency Cohort (CRIC) study.. Baseline kidney clearances of 8 secretory solutes. We measured concentrations of secretory solutes in plasma and paired 24-hour urine specimens using liquid chromatography-tandem mass spectrometry (LC-MS/MS).. Incident heart failure, myocardial infarction, and stroke events.. We used Cox regression to evaluate associations of baseline secretory solute clearances with incident study outcomes adjusting for estimated GFR (eGFR) and other confounders.. Participants had a mean age of 56 years; 45% were women; 41% were Black; and the median estimated glomerular filtration rate (eGFR) was 43 mL/min/1.73 m. Exclusion of patients with severely reduced eGFR at baseline; measurement variability in secretory solutes clearances.. In a national cohort study of CKD, no clinically or statistically relevant associations were observed between the kidney clearances of endogenous secretory solutes and incident heart failure, myocardial infarction, or stroke after adjustment for eGFR. These findings suggest that tubular secretory clearance provides little additional information about the development of cardiovascular disease events beyond glomerular measures of GFR and albuminuria among patients with mild-to-moderate CKD.

Topics: Aged; Albuminuria; Chromatography, Liquid; Cohort Studies; Cresols; Female; Glomerular Filtration Rate; Glycine; Heart Failure; Humans; Incidence; Indican; Kidney Tubules; Kynurenic Acid; Male; Middle Aged; Myocardial Infarction; Organic Anion Transporters; Proportional Hazards Models; Prospective Studies; Pyridoxic Acid; Renal Insufficiency, Chronic; Ribonucleosides; Stroke; Sulfuric Acid Esters; Tandem Mass Spectrometry; Xanthines