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Toxins
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New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic...
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New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic Kidney Disease

A special issue of Toxins (ISSN 2072-6651). This special issue belongs to the section "Uremic Toxins".

Deadline for manuscript submissions: 28 February 2026 | Viewed by 3526

Special Issue Editors

Prof. Dr. Griet Glorieux

E-Mail Website
Guest Editor
Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, 9000 Gent, Belgium
Interests: uremic toxins; protein-bound uremic toxins; chronic kidney disease; leukocyte/monocyte function; leukocyte–endothelial interaction; inflammation in CKD; dialysis fluid purity/endotoxins; gut–kidney axis
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Evelien Snauwaert

E-Mail Website
Guest Editor
Department of Internal Medicine and Pediatrics, Ghent University Hospital, 9000 Ghent, Belgium
Interests: uraemic toxins; chronic kidney disease; pediatrics; Hemodialysis
Prof. Dr. Raymond Vanholder

grade E-Mail Website1 Website2
Guest Editor
Nephrology Section, 0K12, Department of Internal Medicine, Ghent University Hospital, 9000 Ghent, Belgium
Interests: uremia; chronic kidney disease; hemodialysis; adequacy of dialysis; acute kidney injury
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Over the past decade, insights into uremic toxicity have evolved. The introduction of metabolome analyses has offered a more balanced view on uremic retention by revealing the accumulation of not only toxic but also potentially beneficial retention metabolites. All these metabolites, which are secreted by organs or absorbed via the intestine into the circulation, can, together with signaling molecules, receptors, transporter proteins and enzymes, remotely affect multiple organs and lead to disordered communication. Knowledge about the origin (diet, gut microbiota and host metabolism) and biological impact (increased inflammation and sex-related aspects) of uremic toxins has grown. A lot can also be learned from veterinary studies on uremic toxins in kidney disease. While promising innovations for the treatment of advanced kidney failure, such as portable dialysis and bio-artificial kidneys, are under development, increased attention is now also paid to preventive and life-style measures to limit the accumulation of uremic toxins, their toxicity, and their effect on outcomes in CKD. This Special Issue, titled “New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic Kidney Disease”, welcomes submissions related to the topics described above.

Prof. Dr. Griet Glorieux
Prof. Dr. Evelien Snauwaert
Prof. Dr. Raymond Vanholder
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a double-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxins is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • uremic toxins
  • metabolome
  • nutrition
  • diet
  • dialysis
  • sex-related
  • inflammation
  • aryl hydrocarbon receptor
  • post-translational modifications
  • human
  • veterinary

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Published Papers (3 papers)

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Research

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11 pages, 4520 KB  
Article
Kynurenine Promotes Phosphate-Induced Endothelial Calcification via Endothelial-to-Mesenchymal Transition, Osteoblastic Differentiation and AhR Activation
by Martina Molinaro, Mario Cozzolino and Paola Ciceri
Toxins 2025, 17(8), 421; https://doi.org/10.3390/toxins17080421 - 19 Aug 2025
Viewed by 1149
Abstract
In end-stage renal disease (ESRD), the accumulation of solutes normally excreted by the kidneys contributes to multiple complications, including vascular calcification (VC), a key factor in the heightened cardiovascular risk seen in these patients. Among VC drivers, hyperphosphatemia and the uremic milieu are [...] Read more.
In end-stage renal disease (ESRD), the accumulation of solutes normally excreted by the kidneys contributes to multiple complications, including vascular calcification (VC), a key factor in the heightened cardiovascular risk seen in these patients. Among VC drivers, hyperphosphatemia and the uremic milieu are major contributors. Kynurenine, a tryptophan metabolite classified as a uremic toxin, may further exacerbate this process. This study investigated whether kynurenine amplifies high phosphate (Pi)-induced calcification in human aortic endothelial cells (HAEC). Cells were treated with Pi and kynurenine for up to seven days. Kynurenine increased Pi-induced calcium deposition by 36%, accompanied by enhanced endothelial-to-mesenchymal transition (EndMT) and osteoblastic differentiation. Mechanistically, kynurenine activated the aryl hydrocarbon receptor (AhR) pathway, and pharmacological inhibition of AhR partially attenuated this effect. These findings suggest that kynurenine contributes to VC in ESRD by potentiating phosphate-induced endothelial dysfunction via AhR signaling. Full article
(This article belongs to the Special Issue New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic Kidney Disease)
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Review

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21 pages, 1902 KB  
Review
Targeting the Gut–Kidney Axis: Modulation of Gut Microbiota by Traditional Chinese Medicine for Chronic Kidney Disease Management
by Yijing Xin and Libin Pan
Toxins 2025, 17(12), 599; https://doi.org/10.3390/toxins17120599 - 15 Dec 2025
Viewed by 861
Abstract
The interaction between gut microbiota dysbiosis and CKD progression via the “gut–kidney axis” is increasingly recognized. Gut-derived uremic toxins (e.g., indoxyl sulfate and p-cresyl sulfate) accumulate systemically, while beneficial metabolites like short-chain fatty acids (SCFAs) decrease, contributing to inflammation, oxidative stress, and kidney [...] Read more.
The interaction between gut microbiota dysbiosis and CKD progression via the “gut–kidney axis” is increasingly recognized. Gut-derived uremic toxins (e.g., indoxyl sulfate and p-cresyl sulfate) accumulate systemically, while beneficial metabolites like short-chain fatty acids (SCFAs) decrease, contributing to inflammation, oxidative stress, and kidney fibrosis. Traditional Chinese Medicine (TCM), including complex formulae, single herbs, and active ingredients, has long been used to manage CKD. Emerging evidence—primarily from animal studies—highlights its potential to alleviate the disease by modulating the gut microbiota. This review summarizes how TCM interventions re-establish gut microbial symbiosis by regulating microbial composition, reducing toxin load, and reinforcing intestinal barrier integrity, thereby ameliorating systemic inflammation and protecting kidney function. Targeting the gut microbiota represents a promising therapeutic frontier for CKD, and TCM offers a rich resource for developing novel microbiota-modulating strategies. However, future research must focus on validating molecular mechanisms, standardizing TCM preparations, and conducting rigorous clinical trials to facilitate clinical translation. Full article
(This article belongs to the Special Issue New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic Kidney Disease)
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Other

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9 pages, 1002 KB  
Brief Report
Effect of Expanded Hemodialysis with the Theranova Dialyzer on the Platelet-to-Lymphocyte Ratio and Inflammatory Markers
by You Hyun Jeon, Hee-Yeon Jung, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Jeong-Hoon Lim and Jang-Hee Cho
Toxins 2025, 17(11), 521; https://doi.org/10.3390/toxins17110521 - 22 Oct 2025
Viewed by 980
Abstract
The platelet-to-lymphocyte ratio (PLR) has been used as a marker of inflammation, endothelial damage, and a predictor of mortality. Expanded hemodialysis (HDx) using medium cut-off dialyzer (MCO) can effectively clear medium-sized uremic toxins. This study evaluated the effect of the Theranova dialyzer, a [...] Read more.
The platelet-to-lymphocyte ratio (PLR) has been used as a marker of inflammation, endothelial damage, and a predictor of mortality. Expanded hemodialysis (HDx) using medium cut-off dialyzer (MCO) can effectively clear medium-sized uremic toxins. This study evaluated the effect of the Theranova dialyzer, a type of MCO dialyzer, on PLR and uremia-related inflammatory markers. A total of 44 patients with maintenance hemodialysis (HD) using high-flux dialyzer were randomly allocated to the Theranova or high-flux group. PLR and inflammatory markers including fibroblast growth factor 23, tumor necrosis factor-α (TNF-α), and interleukin 6 were evaluated every 4 weeks. The changes in PLR and the reduction ratio of inflammatory markers were compared between two groups during the 12-week study period. The baseline characteristics and PLR were not different between groups. After 12 weeks, the levels of PLR, and TNF-α were significantly lower in the Theranova group compared to the high-flux group (all p < 0.05). The generalized estimating equation model also revealed a significant decrease in PLR over time in the Theranova group than in the high-flux group (p = 0.04). The fold change in 12-week PLR to baseline PLR was lower in the Theranova group than in the high-flux group (p = 0.03). In the multivariable linear regression analysis, the Theranova dialyzer showed a negative correlation with the PLR fold change (β = −0.32, p = 0.04). Our results showed that HDx using the Theranova dialyzer improves PLR over time compared to the high-flux HD. The superior removal of the inflammatory uremic toxins by the Theranova dialyzer may have reduced inflammation and inflammation-related complications in HD patients. Full article
(This article belongs to the Special Issue New Insights in Uremic Toxins and Toxin-Related Outcomes in Chronic Kidney Disease)
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