title: Uremic toxins: a new focus on an old subject.
abstract: The uremic syndrome is characterized by an accumulation of uremic toxins due to inadequate kidney function. The European Uremic Toxin (EUTox) Work Group has listed 90 compounds considered to be uremic toxins. Sixty-eight have a molecular weight less than 500 Da, 12 exceed 12,000 Da, and 10 have a molecular weight between 500 and 12,000 Da. Twenty-five solutes (28%) are protein bound. The kinetics of urea removal is not representative of other molecules such as protein-bound solutes or the middle molecules, making Kt/V misleading. Clearances of urea, even in well-dialyzed patients, amount to only one-sixth of physiological clearance. In contrast to native kidney function, the removal of uremic toxins in dialysis is achieved by a one-step membrane-based process and is intermittent. The resulting sawtooth plasma concentrations of uremic toxins contrast with the continuous function of native kidneys, which provides constant solute clearances and mass removal rates. Our increasing knowledge of uremic toxins will help guide future treatment strategies to remove them.
authors.affiliation: Division of Nephrology and Transplantation, Akdeniz University, Antalya, Turkey.
authors.forename: Asuman
authors.initials: A
authors.lastname: Yavuz
authors.forename: Ciro
authors.initials: C
authors.lastname: Tetta
authors.forename: F Fevzi
authors.initials: FF
authors.lastname: Ersoy
authors.forename: Vincent
authors.initials: V
authors.lastname: D'intini
authors.forename: Ranistha
authors.initials: R
authors.lastname: Ratanarat
authors.forename: Massimo
authors.initials: M
authors.lastname: De Cal
authors.forename: Monica
authors.initials: M
authors.lastname: Bonello
authors.forename: Valeria
authors.initials: V
authors.lastname: Bordoni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Salvatori
authors.forename: Emilio
authors.initials: E
authors.lastname: Andrikos
authors.forename: Gulsen
authors.initials: G
authors.lastname: Yakupoglu
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D015312:Hemodialysis Solutions / Q000008:administration & dosage; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D008567:Membranes, Artificial; D006435:Renal Dialysis / Q000379:methods; D014118:Toxins, Biological / Q000378:metabolism*; D014511:Uremia / Q000378:metabolism*
chemical_list: D000418:Albumins; D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D014118:Toxins, Biological