Nolph K D
Ann Intern Med. 1977 Jan;86(1):93-7. doi: 10.7326/0003-4819-86-1-93.
The cause of the uremic syndrome remains unknown; the success of dialysis therapy suggests that retained, dialyzable, but unidentified toxic solutes may play a role. Since chronic peritoneal dialysis seems to prevent or improve uremic neuropathy as well as does hemodialysis, it has been suggested that retained solutes of "middle molecular weight" (500 to 5000 daltons) may be major toxins. Only body fluid concentrations of these larger solutes are presumed to be reduced by peritoneal dialysis as well as with hemodialysis, whereas small solute concentrations are relatively poorly controlled. There have been numberous hemodialysis studies to examine the toxic potential of "middle molecules" as compared with that of smaller solutes. Although the importance of "middle molecules" as toxins remains unproved, numberous factors influencing their concentrations in body fluid have been discovered. Studies have also shown a surprising tolerance of patients to many variations in dialysis strategies. Difficulties in defining adequate dialysis have been intensified.
尿毒症综合征的病因尚不清楚；透析疗法的成功表明，潴留的、可透析但未明确的毒性溶质可能起了作用。由于慢性腹膜透析似乎与血液透析一样能预防或改善尿毒症神经病变，有人提出“中等分子量”（500至5000道尔顿）的潴留溶质可能是主要毒素。仅推测这些较大溶质的体液浓度可通过腹膜透析以及血液透析而降低，而小溶质浓度的控制相对较差。已经有许多血液透析研究来检验“中等分子”与较小溶质相比的潜在毒性。尽管“中等分子”作为毒素的重要性尚未得到证实，但已发现许多影响其在体液中浓度的因素。研究还表明，患者对许多透析策略的变化具有惊人的耐受性。确定充分透析的难度加大了。
