Aferetica S.r.l, Via Spartaco 10, 40138 Bologna (BO), Italy.
Toxins (Basel). 2021 Mar 30;13(4):246. doi: 10.3390/toxins13040246.
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.
尿毒症毒素的蓄积是导致慢性肾脏病 (CKD) 迅速进展的主要因素之一，尤其是在接受透析治疗的终末期肾病患者中。特别是，蛋白结合尿毒症毒素 (PBUTs) 在 CKD 中似乎具有重要的关键病理生理作用，可诱导各种心血管并发症。通过透析技术从血液中清除尿毒症毒素是限制 CKD 相关并发症的一种已证实的方法。然而，传统的透析主要侧重于清除低分子量和中等分子量的水溶性化合物，而 PBUTs 与蛋白质紧密结合，因此不能有效地被清除。因此，多年来，透析技术通过改进膜结构或使用联合策略来最大程度地清除 PBUTs 并最终预防 CKD 相关并发症而得到了改进。最近的研究结果表明，吸附型体外技术除了常规透析治疗外，还可以在治疗过程中有效地吸附大量的 PBUTs。本综述重点分析了血液净化策略的最新现状，以突出其潜力和局限性，并确定提高毒素清除效果的最可行解决方案，探索可能的未来策略和应用，例如通过减少 PBUTs 的产生和增加其血液清除率来研究协同方法。
