Generation, clearance, toxicity and monitoring possibilities of unaccounted uremic toxins for improved dialysis prescriptions.

Generation, clearance, toxicity and monitoring possibilities of unaccounted uremic toxins for improved dialysis prescriptions. Am J Physiol Renal Physiol. 2018 Mar 14;: Authors: Atherton JG, Hains DS, Bissler JJ, Pendley BD, Lindner E Abstract Current dialysis dosing calculations provide an incomplete assessment of blood purification. They do not include clearances of protein-bound uremic toxins like polyamines, p-cresol sulfate, and indoxyl sulfate, relying solely on the clearance of urea as a surrogate for all molecules accumulating in patients with end stage renal disease (ESRD). Protein-bound uremic toxins clear differently in dialysis but also during normal renal function. The kidney clears protein bound toxins via the process of secretion, while it clears urea through filtration. Herein we review the clearance, accumulation, and toxicity of various uremic toxins. We also suggest possible methods for their monitoring towards the ultimate goal of a more comprehensive dialysis prescription. A more inclusive dialysis prescription would retain the kidney filtration surrogate, urea, and consider at least one protein-bound toxin as a surrogate for uremic toxins cleared through cellular secretion. A more comprehensive assessment of uremic toxins that includes both secretion and filtration is expected to result better understanding of ESRD toxicity and consequently to reduce ESRD mortality. PMID: 29537310 [PubMed - as supplied by publisher]
Source: Am J Physiol Renal P... - Category: Urology & Nephrology Authors: Tags: Am J Physiol Renal Physiol Source Type: research

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