[Uraemic toxins and cardiovascular diseases]

The uremic syndrome is the result of the retention of solutes, which under normal conditions are excreted by the healthy kidneys into the urine. The most practical classification of uremic toxins is based on their physicochemical characteristics that influence their dialytic removal, in (a) small water soluble compounds, (b) the larger "middle molecules," and (c) the protein bound compounds. Most small water soluble compounds are not very toxic and the toxic ones often show a kinetic behavior that is different from that of urea. The incidence of vascular disease and the morbidity and mortality related to it are extremely high in the population of uremic patients. A large proportion of uremic patients suffer from inflammation. Most often, the uremic solutes that play a role in inflammation and cardio-vascular complications are middle molecules and/or protein bound. Protein bound toxins inhibit several biochemical functions. High concentrations of cytokines with an immune activating potential are present in the plasma of uremic patients.