Abstract: SA-PO1192
Phenylacetylglutamine as a Novel Biomarker for Death and Cardiovascular Events in Patients with CKD
Session Information
- CKD: Biomarkers and Emerging Tools for Diagnosis and Monitoring
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Chao, Yu-Lin, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
- Wu, Ping-Hsun, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Tsai, Yi-chun, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Huang, TengHui, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Lin, Ming-Yen, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Hung, Chi-Chih, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Chiu, Yi-Wen, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Lin, Yi-Ting, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Hwang, Shang-Jyh, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
- Kuo, Mei-Chuan, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Kaohsiung City, Taiwan
Background
Phenylacetylglutamine (PAG), a gut microbiota-derived metabolite, has been linked to cardiovascular disease, but its role in chronic kidney disease (CKD) outcomes remains unclear. This study investigated the association of serum PAG with all-cause mortality and major adverse cardiovascular events (MACE) in CKD, and explored related cardiovascular protein biomarkers.
Methods
We conducted a prospective cohort study of 476 CKD patients. Primary outcomes included all-cause mortality and MACE, defined as a composite of acute coronary syndrome, cerebrovascular disease, or acute heart failure hospitalization. Cox proportional hazards models were used to assess the association between natural logarithmic transformation of PAG levels and outcomes, adjusting for demographics, comorbidities, and relevant laboratory parameters including estimated glomerular filtration rate (eGFR) and albuminuria. We also assessed the association between PAG and 184 cardiovascular proteins measured by Olink proteomics CVDII and CVDIII panels.
Results
Patients in the highest PAG tertile were older, had lower hemoglobin, albumin, low-density lipoprotein cholesterol, and eGFR, and higher albuminuria compared to those in the lower tertiles. In Kaplan–Meier survival curve of overall survival and competing death risk method (Fine-Gray approach) of major cardiovascular events shows the highest PAG tertile showed significantly increased rates of mortality and MACE compared to the lowest tertile. In multivariable Cox regression models, natural log-transformed PAG remained independently associated with both mortality (HR 1.88, 95% CI 1.29-2.75) and MACE (subdistribution HR 1.73, 95% CI 1.17-2.56). Moreover, PAG levels were significantly associated with Insulin-like growth factor-binding protein 2 (IGFBP2), N-terminal prohormone brain natriuretic peptide (NT-proBNP), and Trefoil factor 3 (TFF3).
Conclusion
Higher serum PAG levels were independently associated with mortality and MACE in CKD patients, even after adjustment for established risk factors. The associations with specific cardiovascular protein biomarkers suggest potential mechanistic links to cardiovascular pathology. PAG measurement may provide prognostic value and therapeutic insights into managing cardiovascular risk in CKD.