p-Cresol is a by-product of the metabolism of aromatic aminoacid operated by resident intestinal bacteria. In patients with
chronic kidney disease, the accumulation of
p-cresol and of its metabolite p-cresyl-sulphate causes endothelial dysfunction and ultimately increases the cardiovascular risk of these patients. Therapeutic strategies to reduce plasma
p-cresol levels are highly demanded but not available yet. Because it has been reported that the
phosphate binder
sevelamer sequesters
p-cresol in vitro we hypothesized that it could do so also in
peritoneal dialysis patients. To explore this hypothesis we measured total
cresol plasma concentrations in 57 patients with
end-stage renal disease on
peritoneal dialysis, 29 receiving
sevelamer for the treatment of
hyperphosphatemia and 28 patients not assuming this drug. Among the patients not assuming
sevelamer, 16 were treated with
lanthanum whereas the remaining 12 received no drug because they were not hyperphosphatemic. Patients receiving
sevelamer had plasma
p-cresol and serum
high sensitivity C-reactive protein concentrations significantly lower than those receiving
lanthanum or no drug. Conversely, no difference was observed among the different groups either in residual glomerular filtration rate, total weekly dialysis dose, total clearance, urine volume,
protein catabolic rate,
serum albumin or serum
phosphate levels. Multiple linear regression analysis showed that none of these variables predicted plasma
p-cresol concentrations that, instead, negatively correlated with the use of
sevelamer. These results suggest that
sevelamer could be an effective strategy to lower
p-cresol circulating levels in
peritoneal dialysis patients in which it could also favorably affect cardiovascular risk because of its anti-inflammatory effect.