Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium.
J Ren Nutr. 2012 Jan;22(1):90-4. doi: 10.1053/j.jrn.2011.10.026.
Although protein-bound uremic retention solutes are recognized as 1 of the 3 main categories of uremic retention solutes, they only recently have been submitted to thorough analysis. In vitro and ex vivo data link both p-cresyl sulfate and indoxyl sulfate, two of the main compounds of this solute group, to negative impact on the cardiovascular system and progression of kidney failure. Recent in vivo observational data also relate concentration of these compounds to survival outcome, inflammation, and vascular disease in different, even moderate, stages of chronic kidney disease. Removal by different dialysis strategies, even high-flux hemodialysis, is difficult, and only by applying convection, some improvement of removal has been obtained. The other strategy with the potential to decrease concentration is by influencing intestinal generation and/or absorption. The sorbent Kremezin (AST-120) has been shown in controlled studies to decrease protein-bound solute concentration. In pilot controlled studies, AST-120 has been shown to be superior on outcome parameters to placebo. Results from large randomized trials are awaited, before these data can be considered as solid enough to warrant the recommendation to use these compounds for overall therapeutic purposes.
虽然蛋白结合型尿毒症潴留溶质被认为是尿毒症潴留溶质的 3 大主要类别之一，但直到最近才对其进行了全面分析。体外和体内数据都将 p- 硫酸对甲酚和硫酸吲哚酚这两种该溶质组的主要化合物与心血管系统和肾衰竭进展的负面影响联系起来。最近的体内观察性数据还将这些化合物的浓度与不同，甚至是慢性肾脏病中度阶段的生存结果、炎症和血管疾病联系起来。不同的透析策略，甚至高通量血液透析，都难以清除这些物质，只有通过应用对流，才能获得一些清除效果的改善。另一种具有降低浓度潜力的策略是通过影响肠道的生成和/或吸收。吸附剂 Kremezin（AST-120）已在对照研究中显示可降低蛋白结合型溶质的浓度。在小规模对照研究中，AST-120 在预后参数方面优于安慰剂。在这些数据被认为足够可靠，可以推荐用于整体治疗目的之前，还需要等待来自大型随机试验的结果。
