Protein-bound uremic solutes: The forgotten toxins

✍ Scribed by Vanholder, Raymond; De Smet, Rita; Lameire, Norbert

• Book ID: 104474273
• Publisher: Nature Publishing Group
• Year: 2001
• Tongue: English
• Weight: 738 KB
• Volume: 59
• Category: Article
• ISSN: 0085-2538
• DOI: 10.1046/j.1523-1755.2001.59780266.x

✦ Synopsis

The present concept of dialysis focuses mainly on the removal of small water-soluble compounds, and also, the currently applied kinetic parameters of dialysis adequacy are based on the behavior of water-soluble compounds. Nevertheless, many of the currently known biological effects in uremia are attributable to compounds with different physicochemical characteristics, and among these, protein-bound solutes play an important role. In this article, we review the characteristics and consequences of changes in protein binding in uremia, as well as the toxicity of the protein-bound uremic solutes 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indoxyl sulfate, hippuric acid, homocysteine, and p-cresol. Starting from the example of p-cresol, we then summarize the impact of protein-binding on dialytic removal, whereby it is concluded that this removal is largely hampered by this protein-binding compared with that of classic markers such as urea and creatinine. Alternative removal strategies, such as strategies to modify intestinal generation or absorption, are considered.