Background: Children with chronic kidney disease (CKD) are at high risk to develop GIT complications such as intestinal wall edema and increased permeability which contributes to chronic systemic inflammation that increases morbidity and mortality burden. 

Aim: This study aim was to show the relationship between inflammation and increased intestinal permeability in children on hemodialysis (HD). Methods: The study included 50 children with CKD on regular HD of variable duration; their age range was (5−16) years and 40 controls. They were followed up at Nephrology clinic- Eldemerdash hospital. Complete history taking, physical examination were done. Laboratory measurement in the form of zonulin, tumor necrosis factor-alpha (TNF-alpha), high sensitive C-reactive protein (hs-CRP), and alpha1-antitrypsin (AAT) were quantified in serum by ELISA method. 

Results: There was a highly significant decrease in anthropometric measures (weight, height and BMI) and their corresponding z score in cases compared to controls with p ≤ 0.001. Furthermore, there was significant increase of levels of zonulin, TNF-alpha, AAT, and hs-CRP in cases compared to controls with p value of 0.009, 0.001, 0.002, and 0.003, respectively. There was significant positive correlation between zonulin and (TNF-alpha, AAT, hs-CRP, and creatinine) with P values (0.003, 0.001, 0.001, and 0.001), respectively. Zonulin is negatively correlated with weight for age Z score (WAZ) and height with p value (0.01 and 0.018), respectively. TNF-alpha and hs-CRP were negatively correlated with WAZ with P-values of 0.02 and 0.01, respectively. 

Conclusion: Children with CKD on chronic hemodialysis had elevated levels of zonulin, TNF-alpha, hs-CRP, and AAT which reflects gut permeability induced systemic inflammatory state.