{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:08:18Z","timestamp":1788480498229,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Chronic kidney disease (CKD) can lead to cardiac dysfunction in a condition known as cardiorenal syndrome (CRS). It is postulated that the accumulation of uremic toxins in the bloodstream, as a consequence of declining kidney function, may contribute to these adverse cardiac effects. While CRS in adults has been extensively studied, there is a significant knowledge gap with pediatric patients. Uremic toxin levels in children remain inadequately characterized and quantified compared to adults. This review aims to systematically evaluate the association between uremic toxin concentrations and cardiac changes in pediatric CRS and to examine the impact of different dialysis modalities, specifically hemodialysis and peritoneal dialysis, on uremic toxin clearance and cardiovascular parameters. To address this, we conducted a systematic literature search of PubMed, following PRISMA guidelines. We used the terms \u201curemic toxins\u201d and \u201ccardiorenal syndrome\u201d with variations in syntax to search for studies discussing the relationship between uremic toxin levels in CKD, the subsequent impact on cardiac parameters, and the emergence of cardiac dysfunction. Full-text articles written in English, conducted on humans aged from birth to 18 years, and published until December 2021 were included. A comprehensive literature search yielded six studies, and their risk of bias was assessed using JBI Critical Appraisal Checklists. Our systematic review is registered on PROSPERO, number CRD42023460072. This synthesis intends to provide an understanding of the role of uremic toxins in pediatric CRS. The findings reveal that pediatric patients with end-stage CKD on dialysis exhibit elevated uremic toxin levels, which are significantly associated with cardiovascular disease parameters. Additionally, the severity of CKD correlated with higher uremic toxin levels. No conclusive evidence was found to support the superiority of either hemodialysis or peritoneal dialysis in terms of uremic toxin clearance or cardiovascular outcomes. More pediatric-specific standardized and longitudinal studies are needed to develop targeted treatments and improve clinical outcomes and the quality of life for affected children.<\/jats:p>","DOI":"10.3390\/toxins16080345","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T07:01:25Z","timestamp":1723100485000},"page":"345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["A Systematic Review of Uremic Toxin Concentrations and Cardiovascular Risk Markers in Pediatric Chronic Kidney Disease"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4476-2290","authenticated-orcid":false,"given":"Heshini","family":"Dalpathadu","sequence":"first","affiliation":[{"name":"Department of Medical Sciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Cardiac Sciences and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Pediatrics and Alberta Children\u2019s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7559-7329","authenticated-orcid":false,"given":"Aly Muhammad","family":"Salim","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9067-8269","authenticated-orcid":false,"given":"Andrew","family":"Wade","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Alberta Children\u2019s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"},{"name":"Department of Pediatric Nephrology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Greenway","sequence":"additional","affiliation":[{"name":"Department of Cardiac Sciences and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"},{"name":"Department of Pediatrics and Alberta Children\u2019s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta Children\u2019s Hospital, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada"},{"name":"Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000350397","article-title":"Cardiorenal Syndrome Type 4: A Review","volume":"3","author":"Clementi","year":"2013","journal-title":"Cardiorenal Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"E840","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement from the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2906","DOI":"10.1111\/bph.15065","article-title":"Cardiorenal Syndrome: Multi-organ Dysfunction Involving the Heart, Kidney and Vasculature","volume":"177","author":"Savira","year":"2020","journal-title":"Br. 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