title: The other side of the coin: impact of toxin generation and nutrition on the uremic syndrome.
abstract: Both the morbidity of the uremic syndrome and the generation of uremic toxins are attributed to malnutrition. If protein intake and catabolism result in the generation of solutes, then nutritional intake should be related directly to toxicity. On the other hand, inadequate nutrition has been linked to inflammation and mortality. It remains difficult to reconcile these two lines of thought. Several possibilities exist that might account for this apparent paradox: 1) not all nutritional and protein degradation products are toxic; 2) toxins generated from increased protein intake are removed if protein intake is linked to dialysis dose; 3) albumin acts as a buffer for toxicity-hypoalbuminemia favors liberation of protein-bound toxins from their binding sites, enhancing their toxicity; 4) solutes generated from tissue breakdown are more toxic than those generated by nutritional protein; 5) both high and low concentrations of solutes have a negative impact; 6) toxic compounds unrelated to protein breakdown are specific causes of malnutrition and inflammation; 7) and/or residual renal function plays a key role in the elimination of compounds discussed under possibility 6. Thus the uremic syndrome should be considered as a potentially fatal interaction among inflammation, malnutrition, low levels of albumin in the plasma, accumulated protein-bound solutes and generation of nonnutritionally related toxins. Not only optimal dialysis, but also optimal nutritional intake and optimal utilization of these nutrients should help neutralize this chain of events.
mesh_terms: D004044:Dietary Proteins / Q000378:metabolism; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D007677:Kidney Function Tests; D008297:Male; D009751:Nutritional Requirements; D009752:Nutritional Status; D011379:Prognosis; D011502:Protein-Energy Malnutrition / Q000150:complications*; D006435:Renal Dialysis / Q000379:methods; D018570:Risk Assessment; D015996:Survival Rate; D014118:Toxins, Biological / Q000009:adverse effects*
chemical_list: D004044:Dietary Proteins; D014118:Toxins, Biological