Toxin retention is felt to be a major contributor to the development of uremia in patients with advanced chronic kidney disease and end-stage renal disease (ESRD). Uremic retention compounds are classically divided into 3 categories: small solutes, middle molecules, and protein-bound toxins. Compounds comprising the first category, for which the upper molecular weight limit is generally considered to be 500 Da, possess a high degree of water solubility and minimal or absent protein binding. The second category of middle molecules has largely evolved now to be synonymous with peptides and proteins that accumulate in uremia. Although not precisely defined, low-molecular weight proteins as a class have a molecular weight spectrum ranging from approximately 500 to 60,000 daltons. The final category of uremic retention compounds is protein-bound uremic toxins (PBUTs). As opposed to the above small, highly water-soluble toxins, which are largely by-products of protein metabolism, PBUTs have diverse origins and possess chemical characteristics that preclude the possibility of circulation in an unbound form despite being of low molecular weight. This review is the first in a series of papers designed to provide the current state of the art for extracorporeal treatment of ESRD. Subsequent papers in this series will address membranes, mass transfer mechanisms, and future directions. For small solutes and middle molecules, particular emphasis is placed on the important clinical trials that comprise the evidence base regarding the influence of dialytic solute removal on outcome. Because such trials do not exist for PBUTs, the discussion here is instead focused on solute characteristics and renal elimination mechanisms.

A Stokesian dynamics simulation of the effect of surface Couette flow on the microstructure of particles irreversibly adsorbed to an interface is presented. Rather than modeling both bulk phases, the interface, and particles in a full 3D simulation, known interfacial interactions between adsorbed particles are used to create a 2D model from a top down perspective. This novel methodology is easy to implement and computationally inexpensive, which makes it favorable to simulate behavior of particles under applied flow at fluid-fluid interfaces. The methodology is used to examine microstructure deformation of monodisperse, rigid spherical colloids with repulsive interactions when a surface Couette flow is imposed. Simulation results compare favorably to experimental results taken from literature, showing that interparticle forces must be 1 order of magnitude greater than viscous drag for microstructure to transition from aligned particle strings to rotation of local hexagonal domains. Additionally, it is demonstrated that hydrodynamic interactions between particles play a significant role in the magnitude of these microstructure deformations.

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