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Sarcopenia in chronic kidney disease （CKD） occurs mainly in patients with end-stage renal disease （ESRD） on hemodialysis. The potential causes are insufficient nutrition intake, protein and energy consumption, inflammatory cytokines, oxidative stress, insulin resistance and uremic toxins. Protein-bound uremic toxin phenol sulfate is an intestinal-derived uremic toxin accumulating in CKD patients. It is difficult to remove through dialysis. It affects the occurrence of sarcopenia through various ways. The review focused upon the mechanisms of sarcopenia caused by indoxyl sulfate.

Objective: To analyze the relationship between Serum indoxyl sulfate (IS), lysyl oxidase-like protein 2 (LOXL2), glucose-regulated protein 94 (GRP94) and recurrence after radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation (PAF). Methods: 155 patients with PAF who were underwent radiofrequency catheter ablation in our hospital from January 2020 to January 2022 were selected, and followed up for 1 year after operation. The patients were divided into non recurrence group and recurrence group according to whether PAF recurred, and the levels of serum IS, LOXL2 and GRP94 were compared between two groups, and the factors affecting recurrence after operation were analyzed by multivariate logistic regression analysis. The value of serum IS, LOXL2, GRP94 and their combination in predicting the recurrence of patients with PAF after radiofrequency catheter ablation were analyzed by ROC curve. Results: 155 patients with PAF were followed up for 1 year after operation, and 40 cases (25.81%) experienced recurrence. The duration of atrial fibrillation and left atrial diameter (LAD) in recurrence group were longer than those in non recurrence group, the proportion of New York Heart Association (NYHA) cardiac function grade III in recurrence group was higher than that in non recurrence group, and the left ventricular ejection fraction (LVEF) in recurrence group was lower than that in non recurrence group (P<0.05). The level of serum GRP94 in recurrent group was lower than that in the non recurrent group, and the levels of serum IS and LOXL2 were higher than those in non recurrent group (P<0.05). Multivariate logistic regression analysis showed that, NYHA cardiac function grade III, elevated serum IS levels, elevated serum LOXL2 levels, longer duration of atrial fibrillation, and increased LAD were risk factors for recurrence after operation (P<0.05), and elevated serum GRP94 levels and elevated LVEF were protective factors (P<0.05). The ROC curve showed that, the AUC of serum IS, LOXL2, GRP94 levels and their combination in predicting recurrence after operation were 0.764, 0.710, 0.806 and 0.853, respectively, and the AUC of the combination of the three was significantly higher than that of IS, LOXL2 and GRP94. Conclusion: The risk of recurrence after operation increased in patients with PAF with increased serum IS and LOXL2 levels and decreased GRP94 levels before radiofrequency catheter ablation, and the combination of the three can guide the clinical identification of high risk groups of recurrence after operation, and predict the risk of early recurrence after operation. [ABSTRACT FROM AUTHOR]

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