Hydrogen Sulfide-to-Thiosulfate Ratio Associated with Blood Pressure Abnormalities in Pediatric CKD

Identifying children with chronic kidney disease (CKD) at high risk of cardiovascular disease (CVD) and ensuring they receive appropriate treatment can prevent CVD events and mortality later in life. Hydrogen sulfide (H₂S) is a gaseous signaling molecule participating in CVD and CKD. Thiosulfate is not only an oxidation product of H₂S but is also a H₂S donor. We examined whether H₂S, thiosulfate, and their combined ratio have differential associations with CVD risk markers in 56 children and adolescents aged 6–18 years with CKD stages G1–G4. Up to two-thirds of CKD children showed higher BP load on 24 h ambulatory blood pressure monitoring (ABPM), even in the early stage. CKD children with ABPM abnormalities had a higher H₂S-to-thiosulfate ratio, while H₂S-related parameters were not affected by the severity of CKD. The H₂S-to-thiosulfate ratio was positively correlated with 24 h systolic BP (SBP), nighttime SBP, and carotid artery intima-media thickness (cIMT). After adjusting for confounders, H₂S was negatively associated with LV mass, thiosulfate was positively associated with 24-DBP, and the H₂S-to-thiosulfate ratio was positively correlated with nighttime SBP and cIMT. Our data demonstrate differential associations in circulating H₂S, thiosulfate, and their combined ratio with CVD risk in childhood CKD. Further studies are required to determine whether targeting the H₂S signaling pathway can develop novel therapeutic strategies against CVD in this high-risk population.