From the, Institute for Molecular Cardiovascular Research IMCAR, University hospital, Aachen, Germany.
Experimental Vascular Pathology Group, Department of Pathology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands.
J Intern Med. 2021 Sep;290(3):499-526. doi: 10.1111/joim.13248. Epub 2021 Apr 1.
Protein-bound uraemic toxins (PBUTs) accumulate in patients with chronic kidney disease and impose detrimental effects on the vascular system. However, a unanimous consensus on the most optimum approach for the reduction of plasma PBUTs is still lacking.
In this systematic review, we aimed to identify the most efficient clinically available plasma PBUT reduction method reported in the literature between 1980 and 2020. The literature was screened for clinical studies describing approaches to reduce the plasma concentration of known uraemic toxins. There were no limits on the number of patients studied or on the duration or design of the studies.
Out of 1274 identified publications, 101 studies describing therapeutic options aiming at the reduction of PBUTs in CKD patients were included in this review. We stratified the studies by the PBUTs and the duration of the analysis into acute (data from a single procedure) and longitudinal (several treatment interventions) trials. Reduction ratio (RR) was used as the measure of plasma PBUTs lowering efficiency. For indoxyl sulphate and p-cresyl sulphate, the highest RR in the acute studies was demonstrated for fractionated plasma separation, adsorption and dialysis system. In the longitudinal trials, supplementation of haemodialysis patients with AST-120 (Kremezin®) adsorbent showed the highest RR. However, no superior method for the reduction of all types of PBUTs was identified based on the published studies.
Our study shows that there is presently no technique universally suitable for optimum reduction of all PBUTs. There is a clear need for further research in this field.
蛋白质结合型尿毒症毒素（PBUTs）在慢性肾脏病患者中积累，并对血管系统造成有害影响。然而，对于降低血浆 PBUTs 的最佳方法，目前仍没有一致的共识。
在这项系统评价中，我们旨在确定 1980 年至 2020 年文献中报道的最有效的临床可用的降低血浆 PBUT 方法。文献筛选了描述降低已知尿毒症毒素血浆浓度方法的临床研究。对研究的患者数量、研究的持续时间或设计没有限制。
在 1274 篇已确定的出版物中，有 101 篇研究描述了旨在降低 CKD 患者 PBUTs 的治疗选择，被纳入本综述。我们根据 PBUTs 和分析的持续时间将研究分为急性（单次治疗过程的数据）和纵向（多次治疗干预）试验。降低比（RR）被用作衡量血浆 PBUTs 降低效率的指标。对于吲哚硫酸酯和对甲酚硫酸酯，在急性研究中，分段血浆分离、吸附和透析系统显示出最高的 RR。在纵向试验中，用 AST-120（Kremezin®）吸附剂补充血液透析患者显示出最高的 RR。然而，根据已发表的研究，没有确定出一种普遍适用于降低所有类型 PBUTs 的最佳方法。
我们的研究表明，目前没有一种技术普遍适用于最佳降低所有 PBUTs。该领域需要进一步的研究。
