Protein-bound uremic solutes: The forgotten toxins
Protein-bound uremic solutes: The forgotten toxins
复制标题
DOI：
10.1046/j.1523-1755.2001.59780266.x
复制
发表时间：
2001-02-01
影响因子：
19.6
通讯作者：
Lameire, N
中科院分区：
文献类型：
--
作者：
Vanholder, R;De Smet, R;Lameire, N
Please try later.
The present concept of dialysis focuses mainly on the removal of small water-soluble compounds, and also, the currently applied kinetic parameters of dialysis adequacy are based on the behavior of water-soluble compounds. Nevertheless, many of the currently known biological effects in uremia are attributable to compounds with different physicochemical characteristics, and among these, protein-bound solutes play an important role. In this article, we review the characteristics and consequences of changes in protein binding in uremia, as well as the toxicity of the protein-bound uremic solutes 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF), indoxyl sulfate, hippuric acid, homocysteine, and p-cresol. Starting from the example of p-cresol, we then summarize the impact of protein-binding on dialytic removal, whereby it is concluded that this removal is largely hampered by this protein-binding compared with that of classic markers such as urea and creatinine. Alternative removal strategies, such as strategies to modify intestinal generation or absorption, are considered.