“…At present, kynurenine, kynurenic acid, indoleacetic acid, and indoxyl sulfate-all indolic products of tryptophan metabolism-have been shown to bind to the AhR or induce the expression of AhR response genes, such as CYP1A1. 38,[93][94][95][96][97] Moreover, as shown in Table 3, all four metabolites activate the AhR at concentrations either similar to the highest C max determined in dialysis patients (eg, indole acetic acid) or at levels decisively lower than the C max , for instance indoxyl sulfate. To date, the clinical implications of AhR activation in the setting of CKD development and progression remain unclear, however, it has been postulated that uremic solutes might evoke dioxinlike toxicity, 38 leading to suppression of immune responses, induction of carcinogenesis and accelerating tumor growth, and promoting atherosclerosis.…”