Uremia

Meyer, Timothy W.; Hostetter, Thomas H.

doi:10.1056/nejmra071313

Cited by 432 publications

(328 citation statements)

References 64 publications

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“…P rotein-bound uremic retention solutes are implicated in the uremic syndrome and might be a missing link to explain the persistently high mortality rates in chronic kidney disease (CKD) (1)(2)(3). Efforts are mounting to reduce serum concentrations, either by reducing intestinal uptake (4) or by improving blood clearances (5,6).…”

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confidence: 99%

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p-Cresyl Sulfate and Indoxyl Sulfate in Hemodialysis Patients

Meijers¹,

Loor²,

Bammens³

et al. 2009

Clinical Journal of the American Society of Nephrology

153

130

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Background and objectives: Indoxyl sulfate and p-cresyl sulfate are important representatives of the protein-bound uremic retention solutes. Serum levels of p-cresyl sulfate and indoxyl sulfate are linked to cardiovascular outcomes and chronic kidney disease progression, respectively. They share important features such as the albumin-binding site, low dialytic clearance, and both originate from protein fermentation. Whether serum concentrations are related is, however, not known.Design, setting, participants, & measurements: In an observational study in 75 maintenance hemodialysis patients, we studied agreement between indoxyl sulfate and p-cresyl sulfate serum concentrations, dialytic reduction rates, and dialytic clearances. Concentrations were determined by HPLC. Dialytic clearances were determined from total spent dialysate collections. In vitro spiking experiments were performed to explore protein binding characteristics.Results: Indoxyl sulfate and p-cresyl sulfate total serum concentrations were not related (r ‫؍‬ 0.02, P ‫؍‬ 0.9), whereas free serum concentrations were only moderately related (r ‫؍‬ 0.53, P < 0.001). Indoxyl sulfate and p-cresyl sulfate share the same albumin binding site, for which they are competitive binding inhibitors. Intriguingly, indoxyl sulfate and p-cresyl sulfate reduction rates (r ‫؍‬ 0.91, P < 0.001) and dialytic clearances (r ‫؍‬ 0.97, P < 0.001) correlated tightly.Conclusions: Indoxyl sulfate and p-cresyl sulfate serum concentrations are not associated, suggesting different metabolic pathways. Indoxyl sulfate and p-cresyl sulfate are both valid markers to monitor behavior of protein-bound solutes during dialysis. Finally, they are competitive binding inhibitors for the same albumin binding site.

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mentioning

confidence: 99%

“…In addition, both indoxyl sulfate and p-cresyl sulfate are thought to contribute directly to uremic syndrome (1).…”

mentioning

confidence: 99%

p-Cresyl Sulfate and Indoxyl Sulfate in Hemodialysis Patients

Meijers¹,

Loor²,

Bammens³

et al. 2009

Clinical Journal of the American Society of Nephrology

153

130

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“…End-stage CKD frequently leads to uremia, now defined as the accumulation in the blood of organic compounds normally excreted by the kidneys, 12 specifically uremic toxins such as: organic acids, urea, beta-2 microglobulin, compounds resulting from oxidative stress and phosphorus, [13][14][15][16] which are directly related to cardiovascular morbidity and mortality in CKD. In this study, the uremia model obtained with 5/6 nephrectomy was characterized by accumulation of urea and phosphorus, two of the aforementioned uremic toxins.…”

Section: Discussionmentioning

confidence: 99%

Indução de resposta inflamatória sistêmica e espessamento de artérias subepicárdicas em um modelo animal de uremia

Carmona¹,

Rigon²,

Barroso³

et al. 2011

J. Bras. Nefrol.

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“…The recognition that TMAO increases cardiovascular risk now opens a new chapter in this story. Trimethylamine, thought to explain the fishy odor of patients with renal failure [43] , accumulates in renal failure [44] . All the foregoing suggests that patients in renal failure should particularly avoid foods high in carnitine and phosphatidylcholine, such as egg yolk and red meat, and that they may be candidates for treatments to replace harmful intestinal bacteria with beneficial intestinal microbiota [45] .…”

Section: Harm Of Egg Yolks: Beyond Cholesterolmentioning

confidence: 99%

Dietary cholesterol and egg yolk should be avoided by patients at risk of vascular disease

Spence

2016

Journal of Translational Internal Medicine

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Recent recommendations that limits to dietary cholesterol be dropped were probably heavily influenced by propaganda from the egg industry. After conviction for false advertising, the industry has spent hundreds of millions of dollars to convince the public, physicians, and policy makers that dietary cholesterol and egg yolk are harmless. However, there are good reasons for longstanding recommendations that dietary cholesterol be limited to <200 mg/ day in persons at risk of vascular disease. It is seldom understood that this essentially means all people in developed countries who expect to attain an advanced age. There is abundant evidence that dietary cholesterol increases cardiovascular risk. The misdirection of the egg industry focuses on fasting levels of LDL cholesterol, which are only raised by ~ 10% by consumption of egg yolks. However, the main effect of diet is on the post-prandial state: for ~ 4 hours after a high fat/high cholesterol meal, there is oxidative stress, endothelial dysfunction, and arterial inflammation. One large (65 g) egg yolk contains 237 mg of cholesterol, well above the recommended limit-nearly as much as a 12-ounce hamburger. Besides the very high cholesterol content of egg yolk, the phosphatidylcholine in egg yolk leads, via action of the intestinal microbiome, to production of trimethylamine n-oxide (TMAO), which causes atherosclerosis in animal models. Levels of TMAO in the top quartile after a test dose of two egg yolks were associated with a 2.5-fold increase in the 3-year risk of stroke, death, or myocardial infarction among patients referred for coronary angiography. Persons at risk of cardiovascular disease should limit their intake of cholesterol and egg yolk.

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Uremia

Cited by 432 publications

References 64 publications

p-Cresyl Sulfate and Indoxyl Sulfate in Hemodialysis Patients

p-Cresyl Sulfate and Indoxyl Sulfate in Hemodialysis Patients

Indução de resposta inflamatória sistêmica e espessamento de artérias subepicárdicas em um modelo animal de uremia

Dietary cholesterol and egg yolk should be avoided by patients at risk of vascular disease

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