Classification of Uremic Toxins and Their Role in Kidney Failure
Rosner, Mitchell; Reis, Thiago; Husain-Syed, Faeq; Vanholder, Raymond; Hutchison, Colin; Stenvinkel, Peter; Blankestijn, Peter; Cozzolino, Mario; Juillard, Laurent; Kashani, Kianoush; Kaushik, Manish; Kawanishi, Hideki; Massy, Ziad; Sirich, Tammy; Zuo, Li; Ronco, Claudio
(2021) Clinical Journal of the American Society of Nephrology, volume 16, issue 12, pp. 1918 - 1928
(Article)
Abstract
Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the
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basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.
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Keywords: Critical Care and Intensive Care Medicine, Nephrology, Transplantation, Epidemiology, Journal Article
ISSN: 1555-9041
Publisher: American Society of Nephrology
Note: Funding Information: C. Hutchison reports consultancy agreements with, receiving research funding from, and receiving honoraria from Baxter. C. Ronco reports consultancy agreements with Asahi, Astute, Baxter, B. Braun, Biomerieux, Bioporto, Cytosorbents, General Electric (GE), Jafron, Medtronic, OCD, and Toray; receiving honoraria from Astute, Baxter, B. Braun, Estor, Fresenius, GE, Jafron, Medtronic, and Toray; and reports serving as the Editor-in-Chief of Blood Purification and Contributions to Nephrology and Cardiorenal Medicine and as an Associate Editor of Nephrology Dialysis and Transplantation. H. Kawanishi reports receiving honoraria from Kyowa-Kirin Co. Ltd.; reports serving as a scientific advisor or member of PDOPPS Steering Committee; reports serving on the Editorial Boards of Blood Purification, Peritoneal Dialysis International, and The Journal of Vascular Access; and reports serving as president of International Society of Blood Purification. K. Kashani reports consultancy agreements with AM PHARMA; reports receiving research funding from La Jolla Inc.; and reports serving as a scientific advisor or member of GE, La Jolla Inc., and MediBeacon Inc. L. Juillard reports consultancy agreements with Amgen, Astellas, Baxter, Fresenius, Hemotech, Leo, Novartis, Otsuka, Sanofi, and Vifor; reports receiving research funding from Amgen, Baxter, and Sanofi; reports receiving honoraria from Amgen, Astellas, Baxter, Fresenius, Hemotech, Leo, Novartis, Otsuka, Sanofi, and Vifor; and serving as a scientific advisor or member of Amgen, Astellas, Baxter, Fresenius, Hemotech, Leo, Novartis, and Vifor. M. Cozzolino reports receiving research funding from Abbvie, Baxter, Keryx, and Shire; reports receiving honoraria from Abbvie, Amgen, Baxter, Shire, and Vifor-Fresenius; reports serving as a scientific advisor or member of and reports speakers bureau for Abbvie, Amgen, Keryx, Shire, and Vifor. M.H. Rosner reports consultancy agreements with Baxter; reports receiving research funding from Kadmon and National Institutes of Health; reports receiving honoraria from the American Society of Nephrology and Baxter; reports serving as an Editor-at-Large of CJASN; and reports serving as a scientific advisor or member of American Society of Nephrology and on the Data Safety Monitoring Boards of clinical trials sponsored by AstraZeneca, Reata, and Travere. M. Kaushik reports receiving honoraria from and speakers bureau for Baxter Healthcare and Fresenius Medical Care; and serving as a member of ARA-EDTA, European Society of Intensive Care Medicine, International Society of Nephrology, NKF, Singapore Society of Nephrology, and Society of Transplantation Singapore. P.J. Blankestijn reports receiving consulting fees and receiving honoraria, fees paid to the institution, from Baxter and Medtronic; reports receiving research funding from Ablative Solutions, the European Commission, and Recor; and reports serving on the Editorial Board of Nephrology Dialysis Transplantation. P. Stenvinkel reports receiving consultancy fees, research grants, and speaker’s honoraria from Amgen, Astellas, AstraZeneca, Baxter Healthcare, Bayer, Fresenius Medical Care, Pfizer, Reata, and Vifor. R. Van-holder reports consultancy agreements with Baxter Healthcare, BBraun, Fresenius Medical Care, Jafron, Kibow, and Nextkidney Project; has received travel support and honoraria from Baxter Healthcare and B. Braun Avitum; reports serving as an advisor to B. Braun Avitum, Baxter Healthcare, Debiotech, Fresenius Medical Care, Jafron, Kibow, and the Dutch Kidney Foundation; and reports serving as a scientific advisor or member of European Kidney Health Alliance, International Scientific Advisory Board Dutch Kidney Foundation, JASN, Nature Reviews Nephrology, and Nephrology Dialysis Transplantation. T. Reis reports employment with Clinica de Doencas Renais de Brasilia; consultancy agreements with AstraZeneca, Baxter, Contatti Medical (CytoSorbents), and Eurofarma; and reports receiving honoraria and speakers bureau from AstraZeneca, Baxter, B. Braun, Contatti Medical (CytoSorb-ents), Eurofarma, and Jafron. Z. Massy reports receiving research funding from Amgen, Baxter, the French government, Fresenius Medical Care, Genzyme-Sanofi, GlaxoSmithKline, Lilly, Merck Sharp and Dohme-Chibret, and Otsuka and government support for CKD REIN project and experimental projects; reports receiving honoraria on consultation fees to charities or for travel from AstraZeneca, Baxter, and Genzyme-Sanofi; and serving as a scientific advisor or member of Journal of Nephrology, Journal of Renal Nutrition, Kidney International, Nephrology Dialysis Transplantation, and Toxins. All remaining authors have nothing to disclose. Publisher Copyright: © 2021 by the American Society of Nephrology.
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