Abstract
The uremic syndrome is attributed to the progressive retention of a large number of compounds which, under normal conditions, are excreted by healthy kidneys. The compounds are called uremic toxins when they interact negatively with biological functions. The present review focuses on a specific class of molecules, namely the family of protein-bound uremic toxins. Recent experimental studies have shown that protein-bound toxins are involved not only in the progression of chronic kidney disease (CKD), but also in the generation and aggravation of cardiovascular disease. Two protein-bound uremic retention solutes, namely indoxyl sulfate and p-cresyl sulfate, have been shown to play a prominent role. However, although these two molecules belong to the same class of molecules, exert toxic effects on the cardiovascular system in experimental animals, and accumulate in the serum of patients with CKD they may have different clinical impacts in terms of cardiovascular disease and other complications. The principal aim of this review is to evaluate the effect of p-cresyl sulfate and indoxyl sulfate retention on CKD patient outcomes, based on recent clinical studies.
Highlights
Kidney function impairment leads to the progressive retention of a large number of compounds which, under normal conditions, are excreted via the urinary tract [1,2]
The uremic toxins can be classified according to their molecular weight (MW) and their protein-binding ability [3], the most convenient classification being (1) small MW water-soluble compounds; (2) protein-bound compounds; and (3) larger MW compounds, the so-called “middle molecules” [4]
The aim of the present review is to provide new insight into the respective impacts of p-cresyl sulfate and indoxyl sulfate retention for the outcomes of patients with chronic kidney disease (CKD), based on recent clinical studies
Summary
Kidney function impairment leads to the progressive retention of a large number of compounds which, under normal conditions, are excreted via the urinary tract [1,2] Owing to this accumulation, the retained molecules are called uremic retention solutes or, as adopted by the EUTox group, uremic toxins. Toxic effects seem to be induced by compounds which are difficult to remove by dialysis This is true for the second group, namely the protein-bound uremic toxins which are poorly eliminated by the commonly used dialysis techniques. The aim of the present review is to provide new insight into the respective impacts of p-cresyl sulfate and indoxyl sulfate retention for the outcomes of patients with CKD, based on recent clinical studies
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