Abstract
Chronic kidney disease (CKD) is a highly prevalent condition and is associated with a high comorbidity burden, polymedication, and a high mortality rate. A number of conventional and nonconventional risk factors for comorbidities and mortality in CKD have been identified. Among the nonconventional risk factors, uremic toxins are valuable therapeutic targets. The fact that some uremic toxins are gut-derived suggests that intestinal chelators might have a therapeutic effect. The phosphate binders used to prevent hyperphosphatemia in hemodialysis patients act by complexing inorganic phosphate in the gastrointestinal tract but might conceivably have a nonspecific action on gut-derived uremic toxins. Since phosphorous is a major nutrient for the survival and reproduction of bacteria, changes in its intestinal concentration may impact the gut microbiota’s activity and composition. Furthermore, AST-120 is an orally administered activated charcoal adsorbent that is widely used in Asian countries to specifically decrease uremic toxin levels. In this narrative review, we examine the latest data on the use of oral nonspecific and specific intestinal chelators to reduce levels of gut-derived uremic toxins.
Highlights
The nonconventional risk factors include uremic toxins, various harmful compounds that accumulate as renal function declines and that are potential therapeutic targets [3,4]
Indole-3 acetic acid (IAA) is a protein-bound uremic toxin generated by the metabolism of tryptophan and that belongs to the indole family of uremic solutes
This review focused on pharmacological interventions that modulate the concentrations of uremic toxins and prevent the development of harmful effect in Chronic kidney disease (CKD) patients, diet may have a role in the therapeutic strategy
Summary
It was recently shown that patients seen by nephrologists are more difficult to treat than patients seen by other subspecialists, due to the large number of comorbidities, polymedication, and the high mortality risk [2]. A number of conventional and nonconventional risk factors for comorbidities and mortality in CKD have been identified. The nonconventional risk factors include uremic toxins, various harmful compounds that accumulate as renal function declines and that are potential therapeutic targets [3,4]. There are few specific or nonspecific pharmacological strategies for decreasing uremic toxin levels. The objective of the present narrative review was to assess the efficacy of intestinal chelators (e.g., phosphate binders and the orally administered activated charcoal sorbent AST-120 (Kremezin®, Kureha Corporation, Tokyo, Japan)) for the adsorption of gut-derived uremic toxins. We will describe gut-derived uremic toxins, phosphate binders, and the effects of phosphate binders and AST-120 on uremic toxin levels
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