Challenges of reducing protein-bound uremic toxin levels in chronic kidney disease and end stage renal disease.

摘要: The prevalence of chronic kidney disease (CKD) in the worldwide population is currently estimated between 11% and 13%. Adequate renal clearance compromised these patients accumulation a large number uremic retention solutes results an irreversible worsening function which can lead to end stage (ESRD). Approximately three million ESRD receive replacement therapies (RRTs), such as hemodialysis, only partially restore function, they are efficient removing mainly small, unbound from circulation while leaving larger protein-bound toxins (PBUTs) untouched. PBUTs highly increases risk cardiovascular events associated with higher mortality morbidity CKD ESRD. In this review, we address several strategies being explored toward reducing PBUT concentrations, including clinical medical approaches, therapeutic techniques, recent developments RRT technology. These include preservation limitation colon derived PBUTs, oral sorbents, adsorbent technology, use albumin displacers. Despite promising different approaches promote enhanced removal small percentage more than 30 identified on their own, none them provide treatment required efficiency, safety cost-effectiveness prevent CKD-related complications decrease