Future Avenues to Decrease Uremic Toxin Concentration
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- 作者：Raymond C. Vanholder ; MD ; PhD ; raymond.vanholder@ugent.be" class="auth_mail" title="E-mail the corresponding author ; Sunny Eloot ; MSc ; PhD ; Griet L.R.L. Glorieux ; MSc ; PhD
- 关键词：Uremic toxins ; uremic toxin removal ; dialysis adequacy ; intestinal generation ; microbiome ; residual kidney function ; dialysate ; kidney failure ; hemodialysis ; end-stage renal disease (ESRD) ; review
- 刊名：American Journal of Kidney Diseases
- 出版年：2016
- 出版时间：April 2016
- 年：2016
- 卷：67
- 期：4
- 页码：664-676
- 全文大小：781 K
文摘
In this article, we review approaches for decreasing uremic solute concentrations in chronic kidney disease and in particular, in end-stage renal disease (ESRD). The rationale to do so is the straightforward relation between concentration and biological (toxic) effect for most toxins. The first section is devoted to extracorporeal strategies (kidney replacement therapy). In the context of high-flux hemodialysis and hemodiafiltration, we discuss increasing dialyzer blood and dialysate flows, frequent and/or extended dialysis, adsorption, bioartificial kidney, and changing physical conditions within the dialyzer (especially for protein-bound toxins). The next section focuses on the intestinal generation of uremic toxins, which in return is stimulated by uremic conditions. Therapeutic options are probiotics, prebiotics, synbiotics, and intestinal sorbents. Current data are conflicting, and these issues need further study before useful therapeutic concepts are developed. The following section is devoted to preservation of (residual) kidney function. Although many therapeutic options may overlap with therapies provided before ESRD, we focus on specific aspects of ESRD treatment, such as the risks of too-strict blood pressure and glycemic regulation and hemodynamic changes during dialysis. Finally, some recommendations are given on how research might be organized with regard to uremic toxins and their effects, removal, and impact on outcomes of uremic patients.