Chen Ming-Chun, Kuo Chiu-Huang, Lin Yu-Li, Hsu Bang-Gee
Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2025 Apr 11;37(3):264-274. doi: 10.4103/tcmj.tcmj_293_24. eCollection 2025 Jul-Sep.
Uremic toxins (UTs) are bioactive compounds that accumulate in chronic kidney disease (CKD) due to impaired renal clearance, exacerbating disease progression and cardiovascular (CV) complications. These toxins originate from endogenous metabolism, gut microbiota, and dietary intake and include protein-bound UTs such as p-cresyl sulfate, indoxyl sulfate, and indole acetic acid, as well as small, water-soluble toxins such as trimethylamine-N-oxide and phenylacetylglutamine. Their accumulation promotes oxidative stress, inflammation, and endothelial dysfunction, contributing to vascular damage and associated with CV risk. Current management strategies focus on dietary interventions, prebiotics, probiotics, oral sorbents, emerging pharmacological approaches, and advanced dialysis techniques, but clinical outcomes remain inconsistent. Recent trials have demonstrated the potential of agents such as sevelamer, high-amylose-resistant starch, and AST-120 to reduce UT levels and improve certain vascular markers. However, more robust, long-term studies are necessary to fully establish the therapeutic efficacy and optimize treatment strategies to mitigate the impact of gut-derived UTs on CKD and CV health.
尿毒症毒素（UTs）是一类生物活性化合物，在慢性肾脏病（CKD）中，由于肾脏清除功能受损而蓄积，从而加剧疾病进展和心血管（CV）并发症。这些毒素来源于内源性代谢、肠道微生物群和饮食摄入，包括与蛋白质结合的尿毒症毒素，如对甲酚硫酸盐、硫酸吲哚酚和吲哚乙酸，以及小分子水溶性毒素，如氧化三甲胺和苯乙酰谷氨酰胺。它们的蓄积会促进氧化应激、炎症和内皮功能障碍，导致血管损伤并与心血管风险相关。目前的管理策略集中在饮食干预、益生元、益生菌、口服吸附剂、新兴的药理学方法和先进的透析技术上，但临床结果仍不一致。最近的试验表明，司维拉姆、高直链抗性淀粉和AST-120等药物有降低尿毒症毒素水平和改善某些血管标志物的潜力。然而，需要更有力的长期研究来充分确立治疗效果，并优化治疗策略，以减轻肠道源性尿毒症毒素对慢性肾脏病和心血管健康的影响。
