Indoxyl Sulfate Contributes to Impaired Height Velocity in (Pre)School Children.
(2024) Kidney International Reports — Vol. 9, n° 6, p. 1674-1683 (2024)
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- Growth failure is considered the most important clinical outcome parameter in childhood chronic kidney disease (CKD). Central to the pathophysiology of growth failure is the presence of a chronic proinflammatory state, presumed to be partly driven by the accumulation of uremic toxins. In this study, we assessed the association between uremic toxin concentrations and height velocity in a longitudinal multicentric prospective pediatric CKD cohort of (pre)school-aged children and children during pubertal stages. In a prospective, multicentric observational study, a selection of uremic toxin levels of children (aged 0-18 years) with CKD stage 1 to 5D was assessed every 3 months (maximum 2 years) along with clinical growth parameters. Linear mixed models with a random slope for age and a random intercept for child were fitted for height (in cm and SD scores [SDS]). A piecewise linear association between age and height was assumed. Data analysis included data from 560 visits of 81 children (median age 9.4 years; 2/3 male). In (pre)school aged children (aged 2-12 years), a 10% increase in concurrent indoxyl sulfate (IxS, total) concentration resulted in an estimated mean height velocity decrease of 0.002 SDS/yr ( < 0.05), given that CKD stage, growth hormone (GH), bicarbonate concentration, and dietary protein intake were held constant. No significant association with height velocity was found in children during pubertal stages (aged >12 years). The present study demonstrated that, especially IxS contributes to a lower height velocity in (pre)school children, whereas we could not find a role for uremic toxins with height velocity during pubertal stages.
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Snauwaert, E., De Buyser, S., Van Biesen, W., Raes, A., Glorieux, G., Collard, L., Van Hoeck, K., Van Dyck, M., Godefroid, N., Walle, J. V., & Eloot, S. (2024). Indoxyl Sulfate Contributes to Impaired Height Velocity in (Pre)School Children. Kidney International Reports, 9(6), 1674-1683. https://doi.org/10.1016/j.ekir.2024.03.021 (Original work published 2024)