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Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives
Concept Paper

Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

1
Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
2
“Conservative Treatment of Chronic Kidney Disease” Project Group of the Italian Society of Nephrology, 00185 Rome, Italy
3
Department of Medicine and Surgery, University of Parma, Nephrology Unit, Parma University Hospital, 43121 Parma, Italy
*
Author to whom correspondence should be addressed.
Received: 28 February 2021 / Revised: 12 April 2021 / Accepted: 13 April 2021 / Published: 19 April 2021
(This article belongs to the Special Issue New Strategies for the Reduction of Uremic Toxins)
The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment. View Full-Text
Keywords: uremic toxins; nutrition; infrequent dialysis; dietary protein; nutritional therapy; residual kidney function; CKD; ESKD uremic toxins; nutrition; infrequent dialysis; dietary protein; nutritional therapy; residual kidney function; CKD; ESKD
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MDPI and ACS Style

Cupisti, A.; Bolasco, P.; D’Alessandro, C.; Giannese, D.; Sabatino, A.; Fiaccadori, E. Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients. Toxins 2021, 13, 289. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13040289

AMA Style

Cupisti A, Bolasco P, D’Alessandro C, Giannese D, Sabatino A, Fiaccadori E. Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients. Toxins. 2021; 13(4):289. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13040289

Chicago/Turabian Style

Cupisti, Adamasco, Piergiorgio Bolasco, Claudia D’Alessandro, Domenico Giannese, Alice Sabatino, and Enrico Fiaccadori. 2021. "Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients" Toxins 13, no. 4: 289. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins13040289

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