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Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives.
Toxins (Basel). 2021 03 30; 13(4)T

Abstract

Accumulation of uremic toxins represents one of the major contributors to the rapid progression of chronic kidney disease (CKD), especially in patients with end-stage renal disease that are undergoing dialysis treatment. In particular, protein-bound uremic toxins (PBUTs) seem to have an important key pathophysiologic role in CKD, inducing various cardiovascular complications. The removal of uremic toxins from the blood with dialytic techniques represents a proved approach to limit the CKD-related complications. However, conventional dialysis mainly focuses on the removal of water-soluble compounds of low and middle molecular weight, whereas PBTUs are strongly protein-bound, thus not efficiently eliminated. Therefore, over the years, dialysis techniques have been adapted by improving membranes structures or using combined strategies to maximize PBTUs removal and eventually prevent CKD-related complications. Recent findings showed that adsorption-based extracorporeal techniques, in addition to conventional dialysis treatment, may effectively adsorb a significant amount of PBTUs during the course of the sessions. This review is focused on the analysis of the current state of the art for blood purification strategies in order to highlight their potentialities and limits and identify the most feasible solution to improve toxins removal effectiveness, exploring possible future strategies and applications, such as the study of a synergic approach by reducing PBTUs production and increasing their blood clearance.

Authors+Show Affiliations

Aferetica S.r.l, Via Spartaco 10, 40138 Bologna (BO), Italy.Aferetica S.r.l, Via Spartaco 10, 40138 Bologna (BO), Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33808345

Citation

Magnani, Stefania, and Mauro Atti. "Uremic Toxins and Blood Purification: a Review of Current Evidence and Future Perspectives." Toxins, vol. 13, no. 4, 2021.
Magnani S, Atti M. Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives. Toxins (Basel). 2021;13(4).
Magnani, S., & Atti, M. (2021). Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives. Toxins, 13(4). https://doi.org/10.3390/toxins13040246
Magnani S, Atti M. Uremic Toxins and Blood Purification: a Review of Current Evidence and Future Perspectives. Toxins (Basel). 2021 03 30;13(4) PubMed PMID: 33808345.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives. AU - Magnani,Stefania, AU - Atti,Mauro, Y1 - 2021/03/30/ PY - 2021/02/26/received PY - 2021/03/25/revised PY - 2021/03/26/accepted PY - 2021/4/3/entrez PY - 2021/4/4/pubmed PY - 2021/6/30/medline KW - adsorption KW - blood purification KW - hemoperfusion KW - protein-bound toxins KW - uremic toxins JF - Toxins JO - Toxins (Basel) VL - 13 IS - 4 N2 - Accumulation of uremic toxins represents one of the major contributors to the rapid progression of chronic kidney disease (CKD), especially in patients with end-stage renal disease that are undergoing dialysis treatment. In particular, protein-bound uremic toxins (PBUTs) seem to have an important key pathophysiologic role in CKD, inducing various cardiovascular complications. The removal of uremic toxins from the blood with dialytic techniques represents a proved approach to limit the CKD-related complications. However, conventional dialysis mainly focuses on the removal of water-soluble compounds of low and middle molecular weight, whereas PBTUs are strongly protein-bound, thus not efficiently eliminated. Therefore, over the years, dialysis techniques have been adapted by improving membranes structures or using combined strategies to maximize PBTUs removal and eventually prevent CKD-related complications. Recent findings showed that adsorption-based extracorporeal techniques, in addition to conventional dialysis treatment, may effectively adsorb a significant amount of PBTUs during the course of the sessions. This review is focused on the analysis of the current state of the art for blood purification strategies in order to highlight their potentialities and limits and identify the most feasible solution to improve toxins removal effectiveness, exploring possible future strategies and applications, such as the study of a synergic approach by reducing PBTUs production and increasing their blood clearance. SN - 2072-6651 UR - https://www.unboundmedicine.com/medline/citation/33808345/Uremic_Toxins_and_Blood_Purification:_A_Review_of_Current_Evidence_and_Future_Perspectives_ L2 - https://www.mdpi.com/resolver?pii=toxins13040246 DB - PRIME DP - Unbound Medicine ER -