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Review on uremic toxins: classification, concentration, and interindividual variability.
Raymond Vanholder1, Rita De Smet, Griet Glorieux
1The Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium. raymond.vanholder@rug.ac.be
Kidney International
|April 5, 2003
Summary
Uremic toxins vary widely in concentration, with middle molecules and protein-bound compounds showing the most significant toxic ranges. Understanding these concentrations is crucial for accurate uremia research and treatment strategies.
Area of Science:
- Nephrology
- Toxicology
- Biochemistry
Background:
- Accurate uremic toxin concentrations are critical for in vitro, ex vivo, and in vivo experiments.
- Errors in concentration selection can lead to incorrect therapeutic decisions for uremia and its complications.
Purpose of the Study:
- To compile an encyclopedic list of uremic retention solutes.
- To document their normal, uremic, and maximum concentrations, alongside molecular weights.
Main Methods:
- Literature search of 857 publications on uremic toxicity.
- Selection of data from 55 publications covering 90 compounds (1968-2002).
- Analysis included normal concentration (CN), highest uremic concentration (CU), maximum concentration (CMAX), and molecular weight.
Main Results:
- Uremic concentrations (CU/CMAX) consistently exceeded normal concentrations (CN) for all compounds.
- Middle molecules (<500 D) were found at significantly higher concentrations (CU) than smaller molecules.
- Twenty-five solutes (27.8%) were protein-bound, many with known toxicity and high CU/CN ratios.
Conclusions:
- Uremic toxin concentrations span a vast range (ng/L to g/L), particularly for middle and protein-bound molecules.
- Uremic retention is complex, involving numerous solutes beyond urea and creatinine.
- This data provides a foundation for analyzing the relative importance of various uremic toxins.