Uraemic Toxins

Bergström, Jonas; Fürst, Peter

doi:10.1007/978-94-009-9327-3_18

Cited by 6 publications

(3 citation statements)

References 240 publications

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“…Nevertheless, it has as yet not been established which solute(s) cause(s) the various systemic disturbances underlying uremia [1][2][3]. There fore, it has not been possible to develop selective methods of blood purification to remove such solutes.…”

Section: Introductionmentioning

confidence: 99%

Effect of Hemodialysis on Serum Concentrations of HPLC-Analyzed Accumulating Solutes in Uremia

Schoots

Peeters

Gerlag³

1989

Nephron

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The concentration changes, during hemodialysis treatment, of 18 characteristic uremia compounds, analyzed by high-pressure liquid chromatography in sera of renal patients were studied. Pre- to postdialysis concentration ratios (dialysis ratio, D) varied from 0.83 to 3.04 for the different solutes. A division into three solute groups, on the basis of their D values, could be rationalized qualitatively from data on protein binding and dialyzer clearance. One group showed low dialysis ratios which could be explained from plasma protein binding. The second group had intermediate D values, comparable to those of creatinine. For some of the members of the third group, high D values might indicate a compartmentalization and resistance to mass transfer across biological membranes. Among the latter are the tubularly secreted hippuric acid and p-hydroxyhippuric acid. For most of the (protein-bound) solutes, protein binding was shown to decrease during hemodialysis. Protein binding levels were higher after dialysis only for hippuric acid and the as yet unidentified fluorescent solute designated UFK8. In conclusion, the change of serum concentrations and of protein binding resulting from hemodialysis treatment are presented and are compared for 18 accumulating solutes in sera of patients with end-stage renal failure.

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Section: Introductionmentioning

confidence: 99%

Effect of Hemodialysis on Serum Concentrations of HPLC-Analyzed Accumulating Solutes in Uremia

Schoots

Peeters

Gerlag³

1989

Nephron

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“…If the high concentrations of urea can be reduced either by dietary restriction of protein or by improving renal func tion, symptoms usually improve [6]. Despite the relative ly mild toxicity of urea and its poor correlation with renal function, the association of rising serum urea levels with symptoms of uremia and improvement in symptoms as urea falls, suggests that urea is a reasonable marker for accumulated nitrogenous toxins [7], The practice of fol lowing the BUN and serum creatinine that has evolved from several decades of experience with patients prior to their death from uremia has naturally extended into the dialysis era.…”

mentioning

confidence: 99%

“…The poor correlation between dialysis effect and serum creatinine levels was recognized by early quan tifiers of dialysis, so more attention has been focused on control of the urea [10,11]. This seemed appropriate for two reasons: (1) urea is easily dialyzed and is therefore a sensitive indicator of the dialysis effect, and (2) urea reflects total nonprotein nitrogen levels in the body among which are significant uremic toxins [7,12], Control of urea nitrogen that was limited to dietary pro tein restriction in the predialysis era was extended to include dialysis. However, it soon became apparent that neither the effect of dialysis nor the outcome correlated well with serum urea levels.…”

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confidence: 99%

Quantifying Hemodialysis

Depner¹

1996

Am J Nephrol

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The interpretation of traditional serum urea and creatinine concentrations as indices of the severity of uremia requires major modifications in hemodialyzed patients. Although high urea concentrations usually signify worsening uremia and inadequate dialysis, low concentrations do not guarantee a good outcome. Urea production as modified by diet and other factors must also be included in a complete description of dialysis quantity and adequacy. The expression ‘Kt/V’ is a measure of hemodialysis that includes both urea removal and urea generation and is easy to measure from predialysis and postdialysis serum urea concentrations. Kt/V can be most precisely measured with the aid of mathematical models of urea kinetics during and between hemodialyses. Although a reliable measure of the dialysis dose received by most patients, the single-compartment model overestimates serum urea concentrations during hemodialysis and fails to predict the rebound immediately following dialysis. The classic two-compartment model that includes a factor for resistance to diffusion between the compartments, more accurately predicts the BUN profile but fails to account for blood flow-related disequilibrium including cardiopulmonary recirculation. Since solute disequilibrium reduces the effectiveness of hemodialysis, models that incorporate equilibrated urea concentrations both before and after hemodialysis are potentially more accurate tools for quantifying dialysis. Dialysate methods have the potential to accurately measure both solute removal which is the ultimate goal of dialysis, and patient clearance which is considered a better measure of the dialysis effect than dialyzer clearance. Application of these newer techniques requires major changes in sampling methods and changes in analytical equipment that will delay implementation. Meanwhile, analysis of blood-side urea concentrations using the single-compartment, variable volume model provides a reasonable estimate of Kt/V but must be interpreted with due consideration of its well-recognized pitfalls.

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Uremic and Dialysis Encephalopathies

Teschan¹,

Arieff²

1985

Cerebral Energy Metabolism and Metabolic Encephalopathy

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Uraemic Toxins

Cited by 6 publications

References 240 publications

Effect of Hemodialysis on Serum Concentrations of HPLC-Analyzed Accumulating Solutes in Uremia

Effect of Hemodialysis on Serum Concentrations of HPLC-Analyzed Accumulating Solutes in Uremia

Quantifying Hemodialysis

Uremic and Dialysis Encephalopathies

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