An update on protein-bound uremic retention solutes.
Although protein-bound uremic retention solutes are recognized as 1 of the 3 main categories of uremic retention solutes, they only recently have been submitted to thorough analysis. In vitro and ex vivo data link both p-cresyl sulfate and indoxyl sulfate, two of the main compounds of this solute group, to negative impact on the cardiovascular system and progression of kidney failure. Recent in vivo observational data also relate concentration of these compounds to survival outcome, inflammation, and vascular disease in different, even moderate, stages of chronic kidney disease. Removal by different dialysis strategies, even high-flux hemodialysis, is difficult, and only by applying convection, some improvement of removal has been obtained. The other strategy with the potential to decrease concentration is by influencing intestinal generation and/or absorption. The sorbent Kremezin (AST-120) has been shown in controlled studies to decrease protein-bound solute concentration. In pilot controlled studies, AST-120 has been shown to be superior on outcome parameters to placebo. Results from large randomized trials are awaited, before these data can be considered as solid enough to warrant the recommendation to use these compounds for overall therapeutic purposes.
Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium. raymond.vanholder@ugent.be
Raymond
R
Vanholder
Eva
E
Schepers
Anneleen
A
Pletinck
Nathalie
N
Neirynck
Griet
G
Glorieux
D000327:Adsorption; D001798:Blood Proteins / Q000378:metabolism*; D002244:Carbon / Q000627:therapeutic use; D003408:Cresols / Q000097:blood*; D006801:Humans; D007200:Indican / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy; D008863:Microspheres; D010087:Oxides / Q000627:therapeutic use; D011485:Protein Binding; D006435:Renal Dialysis; D013463:Sulfuric Acid Esters; D014511:Uremia / Q000097:blood* / Q000628:therapy
D001798:Blood Proteins; D003408:Cresols; D010087:Oxides; D013463:Sulfuric Acid Esters; C408690:4-cresol sulfate; D002244:Carbon; C040896:AST 120; D007200:Indican