Effect of Serum Indoxyl Sulfate Levels on Patient Survival in Chronic Hemodialysis Patients
Project no. 33034 · Status: Kapanmış (Yayın bekleniyor) · 2025
Summary
<p><span style="color: black;">Chronic kidney disease (CKD)–related mortality is markedly increased in patients receiving hemodialysis, particularly in those with end‑stage kidney disease. In addition to traditional risk factors, protein‑bound uremic toxins are thought to contribute to this increased mortality. Among these toxins, indoxyl sulfate (IS) has attracted considerable attention because of its high protein‑binding capacity, limited dialyzability, and potential systemic effects.</span></p><p><span style="color: black;">This prospective study aimed to evaluate the association between serum total indoxyl sulfate levels and one‑year all‑cause mortality in patients undergoing chronic hemodialysis. A total of 254 patients receiving maintenance hemodialysis were enrolled from multiple centers. Serum total indoxyl sulfate levels were measured at baseline using LC–MS/MS, and patients were followed prospectively for 12 months. Demographic characteristics, comorbidities, dialysis‑related parameters, biochemical and nutritional markers, and the presence of diabetes mellitus were recorded in detail. Factors associated with mortality were analyzed using univariate and multivariate statistical methods.</span></p><p><span style="color: black;">At the end of the follow‑up period, no statistically significant association was observed between serum total indoxyl sulfate levels and all‑cause mortality. However, indoxyl sulfate levels were found to be significantly associated with nutritional parameters such as serum albumin and total protein, as well as with the presence of diabetes mellitus. These findings suggest that nutritional status and diabetes may confound or mask a potential relationship between indoxyl sulfate levels and mortality, thereby limiting the ability to demonstrate this association statistically.</span></p><p><span style="color: black;">In conclusion, serum total indoxyl sulfate levels were not identified as an independent predictor of short‑term mortality in this cohort. The potential modifying effects of nutritional status and diabetes should be taken into account when interpreting the clinical significance of indoxyl sulfate. Further studies with longer follow‑up periods and more comprehensive assessments are needed to better clarify the clinical role of indoxyl sulfate in chronic hemodialysis patients. </span></p>