Intradialytic removal of protein-bound uraemic toxins: role of solute characteristics and of dialyser membrane

Lesaffer, Gerrit; Smet, Rita De; Lameire, Norbert; Dhondt, Annemieke; Duym, Philippe; Vanholder, Raymond

doi:10.1093/ndt/15.1.50

Cited by 236 publications

(199 citation statements)

References 31 publications

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“…65,73,74 Dialysis treatment with protein-leaking membranes has been proposed and it offers a greater clearance of retention protein−bound solutes. Nevertheless, large amounts (2-6 g/4 hours of session) of albumin loss are a major concern 75 because hypoalbuminemia is associated with increased mortality in HD patients.…”

Section: -72mentioning

confidence: 99%

“…116,124 The circulating concentration of free (active) IS remains unchanged in uremic patients, 71 even though one-fifth to one-third of the total IS is removable by HD. 71,73,125 Notably, the free form of IS is undetectable in healthy subjects, 71 suggesting that the equilibrium state of IS-albumin binding is different between healthy persons and CKD patients. In HD patients, serum IS level is independently correlated with serum creatinine.…”

Section: Is Indoxyl Sulfate a Culprit Inmentioning

confidence: 99%

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Cardiorenal Syndrome

Lekawanvijit

Kompa

Wang

et al. 2012

Circulation Research

149

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Cardiorenal syndrome is a condition in which a complex interrelationship between cardiac dysfunction and renal dysfunction exists. Despite advances in treatment of both cardiovascular and kidney disease, cardiorenal syndrome remains a major global health problem. Characteristic of the pathophysiology of cardiorenal syndrome is bidirectional cross-talk; mediators/substances activated by the disease state of 1 organ can play a role in worsening dysfunction of the other by exerting their biologically harmful effects, leading to the progression of the syndrome. Accumulation of uremic toxins is a hallmark of renal excretory dysfunction. Removal of some toxins by conventional dialysis is particularly problematic because of their high protein binding. In this review, we demonstrate that protein-bound uremic toxins may play an important role in progression of cardiovascular disease in the setting of chronic kidney disease. The highly protein-bound uremic toxin indoxyl sulfate has emerged as a potent toxin adversely affecting both the kidney and heart. Direct cardiac effects of this toxin have been recently demonstrated both in vitro and in vivo. Specifically, potent fibrogenic and prohypertrophic effects, as well as oxidative stress-inducing effects, appear to play a central role in both renal and cardiac pathology. Many of these adverse effects can be suppressed by use of a gut adsorbent, AST-120. Potential mechanisms underlying indoxyl sulfate−induced cardiorenal fibrosis are discussed. Future research and clinical implications conclude this review.

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Section: -72mentioning

confidence: 99%

Section: Is Indoxyl Sulfate a Culprit Inmentioning

confidence: 99%

Cardiorenal Syndrome

Lekawanvijit

Kompa

Wang

et al. 2012

Circulation Research

149

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“…In fact, despite their relatively modest strength and low density, plant fibers have been found to be capable of producing fibrous composites with high-specific strength. [8][9][10][11][12][13][14][15][16][17] Cellulose acetate and cellulose triacetate (CTA) are extensively used in the preparation of hemodialysis and desalination membranes. 10 Acetate and triacetate fibers of cellulose have lower strength and abrasion resistance than most man-made fibers, so these are frequently used in combination with synthetic polymers.…”

Section: Introductionmentioning

confidence: 99%

“…10 Acetate and triacetate fibers of cellulose have lower strength and abrasion resistance than most man-made fibers, so these are frequently used in combination with synthetic polymers. [10][11][12][13][14][15] Furthermore, it has been found that among the cellulose esters, CTA has the highest thermal stability. 16 It is known to have better hydrolytic stability and greater resistance to reactions with free chlorine and biodegradation.…”

Section: Introductionmentioning

confidence: 99%

Thermal Stimulated Conductivity in Cellulose Triacetate-Multiwalled Carbon Nanotube Polymer Films

Basavaraja¹,

Jo²,

Kim³

et al. 2010

Bulletin of the Korean Chemical Society

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This paper describes the preparation and study of thermally stimulated discharge conductivity (TSDC) study of cellulose triacetate (CTA) -multiwalled carbon nanotubes (MWNTs) film thermoelectrets. TSDC has been carried out in the temperature range 308 -503 K and at four different polarizing fields. The conductivity of the polymer blends increased with increase in temperature showing a semi-conducting behavior. The apparent activation energy also showed a pronounced effect with the increase in the content of MWNTs.

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“…Clearance of middle molecules and protein-bound uremic solutes will require increases in blood and dialysate flow rates (17)(18)(19)(20)(21)(22). In an ideal scenario, we would know the identities of the molecular mediators of uremia and adjust dialysis settings to optimize their clearance.…”

mentioning

confidence: 99%