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Protein-bound toxins--update 2009.

机译：蛋白质结合毒素-2009年更新。

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Protein-bound uremic retention solutes constitute a group whose common characteristic is their difficult removal by dialysis. In 2003, the EUTox group described 25 protein-bound solutes. They comprised six advanced glycation end products (AGE), four phenols (including p-cresol), six indoles (including indoxylsulfate), two hippurates, three polyamines, and two peptides, homocysteine and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF). As then, three new compounds have been added to the list: phenylacetic acid, dinucleoside polyphosphates, and IL-18. During the last years, protein-bound compounds have been identified as some of the main toxins involved in vascular lesions of chronic kidney disease. The removal of these solutes by conventional hemodialysis (HD) is low because only the free fraction of the solute is available for diffusion. The increase in the convective part with hemodiafiltration improves the performance of depuration but convection only applies to the free fraction and its benefit is limited. One possibility to improve the removal of a protein-bound solute would be to stimulate its dissociation from the binding protein. This could be obtained in experiments by setting the dialysate flow rate and the dialyzer mass transfer area coefficient (KoA) at much higher levels than the plasma flow rate, or by adding to the dialysate a sorbent such as activated charcoal or albumin. In the future, specific adsorbents may be developed. Today, the only possibility is to use approaches such as daily HD and long HD which could allow better equilibration between extravascular and vascular compartments and consequently result in greater removal of protein-bound compounds.
机译：结合蛋白的尿毒症保留溶质组成一个组，其共同特征是难以通过透析去除。 2003年，EUTox小组描述了25种蛋白质结合的溶质。它们包括六种高级糖基化终产物（AGE），四种酚（包括对甲酚），六种吲哚（包括吲哚硫酸盐），两种马尿酸盐，三种多胺和两种肽，高半胱氨酸和3-羧基-4-甲基-5-丙基-2-呋喃丙酸（CMPF）。到那时，已将三种新化合物添加到列表中：苯乙酸，聚磷酸二核苷和IL-18。在过去的几年中，已发现与蛋白质结合的化合物是参与慢性肾脏病血管病变的一些主要毒素。由于仅溶质的游离部分可用于扩散，因此通过常规血液透析（HD）去除这些溶质的几率很低。血液透析滤过对流部分的增加改善了净化的性能，但对流仅适用于游离部分，其益处受到限制。改善去除结合蛋白的溶质的一种可能性是刺激其从结合蛋白上解离。在实验中，可以通过将透析液流速和透析器传质面积系数（KoA）设置为比血浆流速高得多的水平，或者通过向透析液中添加吸附剂（例如活性炭或白蛋白）来获得此值。将来可能会开发特定的吸附剂。今天，唯一的可能性是使用诸如每日HD和长HD之类的方法，这些方法可以更好地平衡血管外腔室和血管腔室，从而更大程度地去除结合蛋白的化合物。

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