Background: Indoxyl sulfate (IS) is a non-dialyzable gut-derived uremic toxin that is reported to be cardiotoxic in patients with advanced chronic kidney disease stages.
Aim of the Work: The aim of this study was to investigate the role of IS as a risk factor for cardiovascular complications in children with end stage kidney disease (ESKD) on regular HD.
Patients and Methods: This is a cross-sectional analytical study that included children with ESKD on regular hemodialysis (HD) for at least 6 months following at Nephrology Unit of Cairo University Pediatric Hospitals. Serum IS level was measured for all patients by the enzyme-linked immunosorbent assay (ELISA). Cardiac complications was assessed using the M mode and 2D transthoracic echocardiography.
Results: The study comprised 88 children with ESKD on regular HD for a mean ± SD of 31.94 ± 26.05 months, with a mean age ± SD of 9 ± 3.2 years (range 3.3- 14 years). Of them 52 (59.1%) were males. Obstructive uropathy (28.4%), and focal segmental glomerulosclerosis (20.5%), were the main causes of ESKD in the study group. Cardiovascular complications were identified in 48 (54.5%) patients in the form of dilated cardiomyopathy in 44 (50%) children with decreased fractional shortening <30% and moderate to severe left ventricular hypertrophy above 95th for age and gender in 10 (11.4%). Cardiovascular affection correlated with duration of HD, hypertension, and IS serum level (p= Conclusion: Cardiac complications are common among children on HD. Both cardiovascular complications and IS accumulation correlated positively with longer duration of HD, and age of children with ESKD. IS is non-dialysable and there is a need to control its production from the gut.