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Development of Human Renal Tubular Epithelial Cell Primary Cultures in Monolayers and Three-Dimensional Conditions
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Future Avenues to Decrease Uremic Toxin Concentration.

Raymond C Vanholder1, Sunny Eloot1, Griet L R L Glorieux1

  • 1Nephrology Department, University Hospital, Gent, Belgium.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|October 27, 2015
PubMed
Summary
This summary is machine-generated.

This review explores methods to reduce uremic toxins in chronic kidney disease (CKD) and end-stage renal disease (ESRD). Strategies include optimizing kidney replacement therapy and addressing intestinal toxin production and kidney function preservation.

Keywords:
Uremic toxinsdialysatedialysis adequacyend-stage renal disease (ESRD)hemodialysisintestinal generationkidney failuremicrobiomeresidual kidney functionreviewuremic toxin removal

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Area of Science:

  • Nephrology
  • Toxicology
  • Biomedical Engineering

Background:

  • Uremic toxins accumulate in chronic kidney disease (CKD) and end-stage renal disease (ESRD).
  • Concentration of uremic toxins correlates with their biological (toxic) effect.
  • Reducing uremic toxin levels is crucial for patient outcomes.

Purpose of the Study:

  • To review current and emerging strategies for decreasing uremic solute concentrations in CKD and ESRD.
  • To discuss extracorporeal therapies, intestinal toxin generation, and kidney function preservation.
  • To provide recommendations for future research on uremic toxins.

Main Methods:

  • Literature review of extracorporeal strategies (hemodialysis, hemodiafiltration, adsorption, bioartificial kidney).
  • Review of intestinal-based therapies (probiotics, prebiotics, synbiotics, sorbents).
  • Analysis of methods for preserving residual kidney function in ESRD patients.

Main Results:

  • Optimizing hemodialysis/hemodiafiltration parameters can enhance toxin removal, particularly for protein-bound solutes.
  • Intestinal interventions show potential but require further investigation due to conflicting data.
  • Careful management of blood pressure, glycemic control, and dialysis-induced hemodynamic changes is vital for preserving kidney function.

Conclusions:

  • Multiple approaches exist to reduce uremic toxin burden in ESRD.
  • Further research is needed to refine intestinal-based therapies and clarify their role.
  • A comprehensive strategy combining optimized dialysis, gut health management, and kidney function preservation is essential for improving ESRD patient outcomes.