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

Faria, Mónica; Pinho, Maria Norberta de

doi:10.1016/j.trsl.2020.09.001

Cited by 26 publications

(28 citation statements)

References 186 publications

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“…A common characteristic of CKD is the presence of chronic morphological and functional disorders in the kidneys, leading to renal failure. The prevalence of CKD among the world’s population currently ranges from 11% to 13% [ 1 , 2 ]. The progressive course of CKD is associated with a steady decline in the glomerular filtration rate to ESRD.…”

Section: General Characteristics Of the Causes And Consequences Of Esrdmentioning

confidence: 99%

“…The number of people with ESRD in the United States alone exceeded 785,000 by the end of 2018 [ 4 ], and there is a steady upward trend in the detection of this pathology [ 5 ]. This is because, during hemodialysis, mainly small solutes are removed from the bloodstream, while larger protein-bound uremic toxins remain in the blood [ 2 ]. The complex action of ESRD-related pathogenic factors causes arterial sclerosis and calcification, as well as other alterations in the cardiovascular system [ 6 ].…”

Section: General Characteristics Of the Causes And Consequences Of Esrdmentioning

confidence: 99%

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The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Гусев

Соломатина

Zhuravleva

et al. 2021

IJMS

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Chronic kidney disease can progress to end-stage chronic renal disease (ESRD), which requires the use of replacement therapy (dialysis or kidney transplant) in life-threatening conditions. In ESRD, irreversible changes in the kidneys are associated with systemic changes of proinflammatory nature and dysfunctions of internal organs, skeletal muscles, and integumentary tissues. The common components of ESRD pathogenesis, regardless of the initial nosology, are (1) local (in the kidneys) and systemic chronic low-grade inflammation (ChLGI) as a risk factor for diabetic kidney disease and its progression to ESRD, (2) inflammation of the classical type characteristic of primary and secondary autoimmune glomerulonephritis and infectious recurrent pyelonephritis, as well as immune reactions in kidney allograft rejection, and (3) chronic systemic inflammation (ChSI), pathogenetically characterized by latent microcirculatory disorders and manifestations of paracoagulation. The development of ChSI is closely associated with programmed hemodialysis in ESRD, as well as with the systemic autoimmune process. Consideration of ESRD pathogenesis from the standpoint of the theory of general pathological processes opens up the scope not only for particular but also for universal approaches to conducting pathogenetic therapies and diagnosing and predicting systemic complications in severe nephropathies.

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Section: General Characteristics Of the Causes And Consequences Of Esrdmentioning

confidence: 99%

Section: General Characteristics Of the Causes And Consequences Of Esrdmentioning

confidence: 99%

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Гусев

Соломатина

Zhuravleva

et al. 2021

IJMS

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“…Furthermore, it is envisioned that molecules belonging to two different classes of uremic toxins proposed by the EUToxsmall water-soluble compounds and middle molecules-can be removed, as they are able to cross the membrane. Prototypes to small water-soluble compounds and middle molecules include urea and β 2 -microglobulin, with a respective MW of 60 Da and 11,818 Da [2]. The third group of uremic toxins, PBUTs, remains a challenge: whilst the free fraction of these molecules (MW < 500 Da) is able to cross the membrane and successfully be removed from the blood circulation, the rejection of the bound fraction will be hindered by the large MW associated with the complexes they form with albumin (>60 kDa).…”

Section: Rejection Coefficients To Low-molecular Weight Water-soluble Uremic Toxinsmentioning

confidence: 99%

“…The progressive loss of kidney function is linked to the retention of metabolic waste products, also known as retention solutes or uremic toxins (UTs), which are normally excreted by healthy kidneys. UTs are classified based on their molecular weight (MW), removal pattern during hemodialysis (HD), and relative affinity for protein binding, and are divided into three major groups: (1) small water-soluble compounds (MW < 500 Da); (2) middle molecules (MW ≥ 500 Da); and (3) protein-bound uremic toxins (PBUTs; MW < 500 Da when free, >66.5 kDa when bound to albumin (MW 66.5 kDa)) [2].…”

Section: Introductionmentioning

confidence: 99%

Novel Cellulose Acetate-Based Monophasic Hybrid Membranes for Improved Blood Purification Devices: Characterization under Dynamic Conditions

et al. 2021

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A novel cellulose acetate-based monophasic hybrid skinned amine-functionalized CA-SiO2-(CH2)3NH2 membrane was synthesized using an innovative method which combines the phase inversion and sol-gel techniques. Morphological characterization was performed by scanning electron microscopy (SEM), and the chemical composition was analyzed by Fourier transform infrared spectroscopy in attenuated total reflection mode (ATR-FTIR). The characterization of the monophasic hybrid CA-SiO2-(CH2)3NH2 membrane in terms of permeation properties was carried out in an in-house-built single hemodialysis membrane module (SHDMM) under dynamic conditions. Permeation experiments were performed to determine the hydraulic permeability (Lp), molecular weight cut-off (MWCO) and the rejection coefficients to urea, creatinine, uric acid, and albumin. SEM confirmed the existence of a very thin (<1 µm) top dense layer and a much thicker bottom porous surface, and ATR-FTIR showed the main bands belonging to the CA-based membranes. Permeation studies revealed that the Lp and MWCO of the CA-SiO2-(CH2)3NH2 membrane were 66.61 kg·h−1·m−2·bar−1 and 24.5 kDa, respectively, and that the Lp was 1.8 times higher compared to a pure CA membrane. Furthermore, the CA-SiO2-(CH2)3NH2 membrane fully permeated urea, creatinine, and uric acid while completely retaining albumin. Long-term filtration studies of albumin solutions indicated that fouling does not occur at the surface of the CA-SiO2-(CH2)3NH2 membrane.

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“…Uremia, also known as end-stage renal disease (ESRD), is a disease in which chronic renal insufficiency progresses to the terminal stage [ 1 ]. This is a metabolic disorder syndrome manifested by an irreversible decline in renal function [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis

Shi

Zhao

et al. 2022

Computational and Mathematical Methods in Medicine

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Objective. This meta-analysis is aimed at systematically assessing the efficacy and prognosis of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of end-stage renal disease (ESRD). Methods. China National Knowledge Infrastructure, VIP, SinoMed, Cochrane Library, PubMed, and Embase databases were searched for relevant studies to evaluate the two different dialysis methods for ESRD. The search time was set from 2010 to 2021. Meta-analysis was performed using Stata16.0. The treatment group received PD, while the control group was given HD. Results. Out of 317 articles initially retrieved, 14 studies were finally included in our meta-analysis. The analysis results showed that there was no marked difference in the 1-year survival rate between the two groups ( RR = 1.05 ; 95% CI: 1.00, 1.10; P > 0.05 ), but the incidence rate of adverse reactions in the treatment group was significantly lower than that in the control group ( RR = 0.51 ; 95% CI: 0.37, 0.70; P < 0.05 ). In addition, PD and HD treatments caused significant decreases in serum creatinine levels (PD, SMD = − 2.91 ; 95% CI: -3.79, -2.04; P < 0.05 ; HD, SMD = − 3.09 ; 95% CI: -4.01, -2.16; P < 0.05 ) and blood urea nitrogen levels (PD, SMD = − 2.54 , 95% CI: -3.37, -1.72, P < 0.05 ; HD, SMD = − 2.62 , 95% CI: -3.47, -1.77, P < 0.05 ); however, there was no significant statistical difference in posttreatment levels of serum creatinine and blood urea nitrogen between the two groups. Compared with the control group, the hemoglobin ( SMD = 0.56 , 95% CI: 0.07, 1.06; P < 0.05 ) and serum albumin ( SMD = 1.11 , 95% CI: 0.46, 1.76, P < 0.05 ) levels were significantly increased in the treatment group after treatment. Conclusion. In summary, both PD and HD can improve renal function in uremic patients, but PD is superior to HD in reducing the incidence of adverse reactions, improving the nutritional status, and therefore improving the quality of life of patients.

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

Cited by 26 publications

References 186 publications

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

The Pathogenesis of End-Stage Renal Disease from the Standpoint of the Theory of General Pathological Processes of Inflammation

Novel Cellulose Acetate-Based Monophasic Hybrid Membranes for Improved Blood Purification Devices: Characterization under Dynamic Conditions

Comparative Analysis of Efficacy and Prognosis of Hemodialysis and Peritoneal Dialysis for End-Stage Renal Disease: A Meta-analysis

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