The role of indoxyl sulfate in renal anemia in patients with chronic kidney disease

Chih Jen Wu, Cheng Yi Chen, Thung S. Lai, Pei Chen Wu, Chih Kuang Chuang, Fang Ju Sun, Hsuan Liang Liu, Han Hsiang Chen, Hung I. Yeh, Chih-Sheng Lin, Cheng Jui Lin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Renal anemia is a common complication in patients with advanced chronic kidney disease. In vitro studies have shown that indoxyl sulfate decreases erythropoietin production. Whether this effect is seen in vivo remains unclear. Our goal was to explore the role of indoxyl sulfate in renal anemia. We found serum indoxyl sulfate levels are significantly and negatively associated with erythropoietin levels in human. A multiple stepwise linear regression analyses after adjustment for other independent parameters revealed that free indoxyl sulfate, and total indoxyl sulfate were significantly associated with erythropoietin levels. In animal studies, erythropoietin gene and protein expression were markedly inhibited in rats with chronic kidney disease; however, this effect was significantly reversed by lowering serum indoxyl sulfate with AST-120. Indoxyl sulfate may also inhibit erythropoietin expression in animal models with chronic kidney disease. These findings further support the role of indoxyl sulfate in the development of renal anemia.

Original languageEnglish
Pages (from-to)83030-83037
Number of pages8
Issue number47
StatePublished - 1 Jan 2017


  • Chronic kidney disease
  • Erythropoietin
  • Indoxyl sulfate
  • Renal anemia


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