Journal ArticleDOI
Removal of the uremic retention solute p-cresol using fractionated plasma separation and adsorption.
Björn Meijers,Viktoria Weber,Bert Bammens,Wim Dehaen,Kristin Verbeke,Dieter Falkenhagen,Pieter Evenepoel +6 more
TLDR
Fractionated plasma separation and adsorption (FPSA) is a nonbiologic detoxification system for the treatment of liver failure as discussed by the authors, which is a promising technique to improve clearance of protein-bound uremic retention solutes.Abstract:
Removal of protein-bound uremic retention solutes, including p-cresol, by peritoneal dialysis and hemodialysis (HD) is limited. p-Cresol, mainly circulating as sulfate conjugate (p-cresyl sulfate [PCS]), is independently associated with mortality. Fractionated plasma separation and adsorption (FPSA) is a nonbiologic detoxification system for the treatment of liver failure. The FPSA clearance of uremic retention solutes is unknown. We studied PCS clearance by FPSA, using the Prometheus system. The neutral resin adsorbent and the anion exchange adsorbent bind PCS in vitro (reduction ratios [RRs] 37 and 70%). Ex vivo, the adsorbent mass removal (MR) (median 47.5 mg) contributes more than half to total MR (median 89.6 mg). In vivo, PCS RR during FPSA (50%) exceeded the RR during high flux HD (30%). We halted the study after four inclusions due to repeated thrombosis of the arterio-venous conduit. In conclusion, FPSA is a promising technique to improve clearance of protein-bound uremic retention solutes.read more
Citations
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Journal ArticleDOI
The Uremic Toxicity of Indoxyl Sulfate and p-Cresyl Sulfate: A Systematic Review
TL;DR: A systematic approach allowed the retrieval of methodologically correct studies unbiased by erroneous conditions related to albumin binding, and the data seem to confirm the toxicity of indoxyl sulfate and p-cresyl sulfates and support their roles in vascular and renal disease progression.
Journal ArticleDOI
p -Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin
TL;DR: The prebiotic oligofructose-enriched inulin significantly reduced p-cresyl sulfate generation rates and serum concentrations in haemodialysis patients, and whether reduction of p-Cresyl sulfur concentrations, an independent predictor of cardiovascular disease in HD patients, will result in improved cardiovascular outcomes remains to be proven.
Journal ArticleDOI
p-Cresyl sulfate
TL;DR: Since pCS remains difficult to remove by dialysis, the gut microbiota could be a future target to decrease pCS levels and its toxicity, even at earlier stages of CKD, aiming at slowing down the progression of the disease and decreasing the cardiovascular burden.
Journal ArticleDOI
The uremic retention solute p-cresyl sulfate and markers of endothelial damage.
Björn Meijers,Soetkin Van kerckhoven,Kristin Verbeke,Wim Dehaen,Yves Vanrenterghem,Marc Hoylaerts,Pieter Evenepoel +6 more
TL;DR: It is suggested that p-cresyl sulfate alters endothelial function in hemodialysis patients by inducing shedding of endothelial microparticles in the absence of overt endothelial damage in vitro and is independently associated with the number of endothelium microp articles in he modialsysis patients.
Journal ArticleDOI
Protein-bound uraemic toxin removal in haemodialysis and post-dilution haemodiafiltration
Detlef H. Krieter,Andrea Hackl,Annie Rodriguez,Leila Chenine,Hélène Leray Moragues,Horst-Dieter Lemke,Christoph Wanner,Bernard Canaud +7 more
TL;DR: The elimination of protein-bound compounds into dialysate is predicted by the level of pre-treatment plasma concentrations and depends particularly on diffusion, which emphasizes the minor significance of convection for the clearance of these solutes.
References
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Journal ArticleDOI
Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis
Garabed Eknoyan,Gerald J. Beck,Alfred K. Cheung,John T. Daugirdas,Tom Greene,John W. Kusek,Michael Allon,James L. Bailey,James A. Delmez,Thomas A. Depner,Johanna T. Dwyer,Andrew S. Levey,Nathan W. Levin,Edgar L. Milford,Daniel B. Ornt,Michael V. Rocco,Gerald Schulman,Steve J. Schwab,Brendan P. Teehan,Robert D. Toto +19 more
TL;DR: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.
Journal ArticleDOI
Review on uremic toxins: Classification, concentration, and interindividual variability
Raymond Vanholder,Rita De Smet,Griet Glorieux,Àngel Argilés,Ulrich Baurmeister,Philippe Brunet,William R. Clark,Gerald Cohen,Peter Paul De Deyn,Reinhold Deppisch,Béatrice Descamps-Latscha,Thomas Henle,Achim Jörres,Horst Dieter Lemke,Ziad A. Massy,Jutta Passlick-Deetjen,Mariano Rodriguez,Bernd Stegmayr,Peter Stenvinkel,Ciro Tetta,Christoph Wanner,Walter Zidek +21 more
TL;DR: Concentrations of retention solutes in uremia vary over a broad range, from nanograms per liter to grams per liter, and a substantial number of molecules are protein bound and/or middle molecules, and many of these exert toxicity and are characterized by a high range of toxic over normal concentration (CU/CN ratio).
Journal ArticleDOI
Effects of Increased Peritoneal Clearances on Mortality Rates in Peritoneal Dialysis: ADEMEX, a Prospective, Randomized, Controlled Trial
Ramón Paniagua,Dante Amato,Edward F. Vonesh,Ricardo Correa-Rotter,Alfonso Ramos,John Moran,Salim Mujais +6 more
TL;DR: Evidence is provided that increases in peritoneal small-solute clearances within the range studied have a neutral effect on patient survival, even when the groups are stratified according to a variety of factors known to affect survival.
Journal ArticleDOI
Improvement of hepatorenal syndrome with extracorporeal albumin dialysis mars: Results of a prospective, randomized, controlled clinical trial
Steffen Mitzner,Jan Stange,Sebastian Klammt,Teut Risler,Christiane M. Erley,Brigitte D. Bader,Elke D. Berger,W. Lauchart,P. Peszynski,Jens Freytag,Heiko Hickstein,J. Loock,Johannes-Mathias Löhr,Stefan Liebe,Jörg Emmrich,Gero Korten,Reinhard Schmidt +16 more
TL;DR: It is concluded that the removal of albumin‐bound substances with the MARS method can contribute to the treatment of type I HRS.
Journal ArticleDOI
Free serum concentrations of the protein-bound retention solute p-cresol predict mortality in hemodialysis patients
TL;DR: The data suggest that free serum levels of p-cresol, a representative of the protein-bound uremic retention solutes, are associated with mortality in HD patients, and may encourage nephrologists to widen their field of interest beyond the scope of small water-soluble ureming solutes and middle molecules.
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Review on uremic toxins: Classification, concentration, and interindividual variability
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