Intestinal Chelators, Sorbants, and Gut-Derived Uremic Toxins

Abstract

Chronic kidney disease (CKD) is a highly prevalent condition and is associated with a high comorbidity burden, polymedication, and a high mortality rate. A number of conventional and nonconventional risk factors for comorbidities and mortality in CKD have been identified. Among the nonconventional risk factors, uremic toxins are valuable therapeutic targets. The fact that some uremic toxins are gut-derived suggests that intestinal chelators might have a therapeutic effect. The phosphate binders used to prevent hyperphosphatemia in hemodialysis patients act by complexing inorganic phosphate in the gastrointestinal tract but might conceivably have a nonspecific action on gut-derived uremic toxins. Since phosphorous is a major nutrient for the survival and reproduction of bacteria, changes in its intestinal concentration may impact the gut microbiota’s activity and composition. Furthermore, AST-120 is an orally administered activated charcoal adsorbent that is widely used in Asian countries to specifically decrease uremic toxin levels. In this narrative review, we examine the latest data on the use of oral nonspecific and specific intestinal chelators to reduce levels of gut-derived uremic toxins.

Chronic kidney disease and neurological disorders: are uraemic toxins the missing piece of the puzzle?

“…However, there are few therapeutic options. Although phosphate binders can effectively reduce phosphate levels, repositioned products from this drug class do not appear to greatly decrease circulating levels of other uraemic toxins [ 90 ]. The orally administered activated charcoal adsorbent AST-120 is widely used in Asian countries to specifically decrease uraemic toxin levels.…”

Uremic Toxins and Cardiovascular Risk in Chronic Kidney Disease: What Have We Learned Recently beyond the Past Findings?

“…CVD is a major problem in patients with CKD and constitutes the leading cause of death in this population [19]. Strategies implemented to modify UT levels have been described in previous reviews [11,191]. A combined approach of targeting UTs with the other aspects of CVD could be necessary for its prevention.…”

Uremic encephalopathy

“…123 Nevertheless, clinical studies evaluating neurological outcomes with this approach are lacking. 124 This non-invasive strategy could be valuable in palliative care situations or in patients treated by incremental dialysis. 125 Hemoperfusion is another extracorporeal blood purification technique applied in the treatment of uremic encephalopathy.…”