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Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, as conventional dialysis is often insufficient. With advancements in the classification and understanding of UTs, spearheaded by the European Uremic Toxins (EUTox) working group, over 120 molecules have been identified, prompting the development of alternative therapeutic strategies. Innovations such as online hemodiafiltration aim to enhance the removal process, while novel adsorptive therapies offer a means to address the high affinity of PBUTs to plasma proteins. Furthermore, the exploration of molecular displacers, designed to increase the free fraction of PBUTs, represents a cutting-edge approach to facilitate their dialytic clearance. Despite these advancements, the clinical application of displacers requires more research to confirm their efficacy and safety. The pursuit of such innovative treatments is crucial for improving the management of uremic toxicity and the overall prognosis of CKD patients, emphasizing the need for ongoing research and clinical trials.
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http://dx.doi.org/10.3390/jcm13051428 | DOI Listing |
Probiotics Antimicrob Proteins
September 2025
Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, SP, 17525-902, Brazil.
The symbiosis between intestinal bacteria and the human body's physiological processes can modulate health. The intestinal microbiota is linked to the development of neurotrophic factors; therefore, it is increasingly related to the modulation of nervous system pathologies. Moreover, microbiota can interfere with inflammation and oxidative stress, which are closely linked to cardiovascular risk factors and several other inflammatory conditions, such as kidney and neurodegenerative diseases.
View Article and Find Full Text PDFCurr Dev Nutr
September 2025
Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland.
Background: Galacto-oligosaccharides (GOS) intake has been linked to health benefits via modulation of the gut microbiome. Milk, where the majority of lactose is enzymatically converted to GOS (called here Novel or "N milk"), retains milk's nutritional value with reduced lactose and a high amount of prebiotic GOS.
Objectives: The aim of this study was to investigate the effect of N milk on the gut microbiome and related changes in health-related biomarkers, complemented by ex vivo fermentation experiments.
Sci Adv
August 2025
Department of Clinical Biology and Hormonal Regulation, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8574, Japan.
Chronic kidney disease (CKD) is a life-threatening condition, and constipation is a progressive risk factor. We evaluated changes in uremic toxins, renal function, and the safety of lubiprostone, a selective chloride channel activator, in patients with CKD. In this phase 2, randomized, double-blind, placebo-controlled trial across nine centers in Japan, 150 patients with stage IIIb-IV CKD received lubiprostone (8 or 16 micrograms) or placebo for 24 weeks.
View Article and Find Full Text PDFInt J Mol Sci
August 2025
State Key Laboratory for Innovation and Transformation of Luobing Theory, Key Laboratory of Cardiovascular Remodeling and Function Research of MOE, NHC, CAMS and Shandong Province, Department of Cardiology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan
Chronic kidney disease (CKD) is associated with a significantly elevated mortality rate, primarily due to cardiovascular disease (CVD), highlighting a complex bidirectional relationship between the two conditions. Life-threatening cardiovascular events occur despite control of the traditional risk factors, emphasizing the underlying role of non-traditional risk factors. CKD, causing mineral imbalance and the accumulation of uremic toxins due to a compromised ability to excrete waste products, imposes extra pressure on the cardiovascular system.
View Article and Find Full Text PDFJ Formos Med Assoc
August 2025
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan; Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan City, Taiwan. Electronic address:
Objective: Hemodialysis patients frequently exhibit altered gut microbiota and elevated indoxyl sulfate (IS) levels, a uremic toxin linked to negative health outcomes. This study explores how probiotic supplementation may be associated with changes in uremic toxins and sleep quality in hemodialysis patients through its relationship with gut microbiota.
Design And Methods: This open-label, randomized cohort study involved 80 hemodialysis patients with poor sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) Global Score.