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Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis

  • Authors:
    • Maria Divani
    • Aikaterini Katsanaki
    • Panagiota Makri
    • Christina Poulianiti
    • Evangelos Lykotsetas
    • Andriani Balatsouka
    • Maria Tziastoudi
    • Ioannis Stefanidis
    • Theodoros Eleftheriadis
  • View Affiliations / Copyright

    Affiliations: Department of Nephrology, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
    Copyright: © Divani et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 29
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    Published online on: April 1, 2026
       https://doi.org/10.3892/mi.2026.313
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Abstract

Cardiovascular disease (CVD) is the leading cause of mortality in patients undergoing hemodialysis (HD). Uremic toxins may play a role in this process. One such toxin is kynurenine, a product of tryptophan metabolism that is not cleared sufficiently by HD. In the present study, serum kynurenine and tryptophan levels were measured using ELISA in 119 patients undergoing HD and 25 healthy subjects. In total, 41 patients had coronary heart disease (CHD), 61 patients had heart failure (HF), 27 patients had HF with reduced ejection fraction (HFrEF) and 33 patients had atrial fibrillation (AF). Factors that may influence kynurenine levels in patients undergoing HD, and the associations between kynurenine and CHD, HF and AF were examined. Compared with the healthy individuals, patients undergoing HD had higher kynurenine levels (7.56 vs. 2.33 µM; P<0.001). In patients undergoing HD, kynurenine negatively correlated with inflammatory markers. Kynurenine levels were significantly higher in patients undergoing HD with HFrEF (8.78 vs. 7.56 µM; P=0.03) and AF (9.15 vs. 7.30 µM; P=0.011). Following adjustment, for every 1 µM increase in serum kynurenine levels, the odds ratios for HFrEF and AF were 1.65 (P=0.008) and 1.37 (P=0.039), respectively. On the whole, the present study demonstrates that in patients undergoing HD, serum kynurenine levels are elevated, and are associated with HFrEF and AF. These findings suggest a potential role for this uremic toxin in the development of these cardiovascular disorders. 
View Figures

Figure 1

Scatterplots of statistically
significant correlations of kynurenine with other variables in
patients undergoing hemodialysis. Scatterplots depicting kynurenine
in relation to (A) age, (B) the duration of hemodialysis treatment,
(C) white blood cell count, (D) neutrophil count, (E)
neutrophil-to-lymphocyte ratio, (F) creatinine levels, (G)
C-reactive protein, and (H) the kynurenine-to-tryptophan ratio.

Figure 2

ROC curve analysis evaluating the
ability of kynurenine to detect HFrEF and AF. (A) ROC curve
analysis revealed a modest discriminative ability of kynurenine for
HFrEF, with an AUC of 0.637 (95% CI, 0.520-0.754; P=0.022). (B)
Similarly, ROC curve analysis demonstrated a modest discriminative
ability of kynurenine for AF, with an AUC of 0.652 (95% CI,
0.545-0.758; P=0.005). ROC, receiver operating characteristic;
HFrEF, heart failure with reduced ejection fraction; AF, atrial
fibrillation.
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Spandidos Publications style
Divani M, Katsanaki A, Makri P, Poulianiti C, Lykotsetas E, Balatsouka A, Tziastoudi M, Stefanidis I and Eleftheriadis T: Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis. Med Int 6: 29, 2026.
APA
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A. ... Eleftheriadis, T. (2026). Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis. Medicine International, 6, 29. https://doi.org/10.3892/mi.2026.313
MLA
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A., Tziastoudi, M., Stefanidis, I., Eleftheriadis, T."Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis". Medicine International 6.3 (2026): 29.
Chicago
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A., Tziastoudi, M., Stefanidis, I., Eleftheriadis, T."Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis". Medicine International 6, no. 3 (2026): 29. https://doi.org/10.3892/mi.2026.313
Copy and paste a formatted citation
x
Spandidos Publications style
Divani M, Katsanaki A, Makri P, Poulianiti C, Lykotsetas E, Balatsouka A, Tziastoudi M, Stefanidis I and Eleftheriadis T: Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis. Med Int 6: 29, 2026.
APA
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A. ... Eleftheriadis, T. (2026). Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis. Medicine International, 6, 29. https://doi.org/10.3892/mi.2026.313
MLA
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A., Tziastoudi, M., Stefanidis, I., Eleftheriadis, T."Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis". Medicine International 6.3 (2026): 29.
Chicago
Divani, M., Katsanaki, A., Makri, P., Poulianiti, C., Lykotsetas, E., Balatsouka, A., Tziastoudi, M., Stefanidis, I., Eleftheriadis, T."Kynurenine levels are elevated in patients with heart failure with reduced ejection fraction or atrial fibrillation undergoing hemodialysis". Medicine International 6, no. 3 (2026): 29. https://doi.org/10.3892/mi.2026.313
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