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  1. Article ; Online: Approaches to uremia.

    Meyer, Timothy W / Hostetter, Thomas H

    Journal of the American Society of Nephrology : JASN

    2014  Volume 25, Issue 10, Page(s) 2151–2158

    Abstract: The development of dialysis was a dramatic step forward in medicine, allowing people who would soon have died because of lack of kidney function to remain alive for years. We have since found, however, that the "artificial kidney" does not live up fully ... ...

    Abstract The development of dialysis was a dramatic step forward in medicine, allowing people who would soon have died because of lack of kidney function to remain alive for years. We have since found, however, that the "artificial kidney" does not live up fully to its name. Dialysis keeps patients alive but not well. Part of the residual illness that dialysis patients experience is caused by retained waste solutes that dialysis does not remove as well as native kidney function does. New means are available to identify these toxic solutes, about which we currently know remarkably little, and knowledge of these solutes would help us to improve therapy. This review summarizes our current knowledge of toxic solutes and highlights methods being explored to identify additional toxic solutes and to enhance the clearance of these solutes to improve patient outcomes.
    MeSH term(s) Animals ; Humans ; Kidney Failure, Chronic/complications ; Kidney Failure, Chronic/therapy ; Kidney Tubules/metabolism ; Renal Dialysis ; Urea/blood ; Uremia/blood ; Uremia/etiology
    Chemical Substances Urea (8W8T17847W)
    Language English
    Publishing date 2014-05-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ZDB-ID 1085942-1
    ISSN 1533-3450 ; 1046-6673
    ISSN (online) 1533-3450
    ISSN 1046-6673
    DOI 10.1681/ASN.2013121264
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3344: Show issues Location:
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  2. Article ; Online: Editorial: Novel therapeutic approaches in chronic kidney disease and uremia management.

    Tantisattamo, Ekamol / Kalantar-Zadeh, Kamyar

    Current opinion in nephrology and hypertension

    2019  Volume 29, Issue 1, Page(s) 1–3

    Language English
    Publishing date 2019-11-13
    Publishing country England
    Document type Editorial
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000575
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 3686: Show issues Location:
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  3. Article ; Online: Editorial: Novel therapeutic approaches in chronic kidney disease, uremia and kidney transplantation: past, present and future.

    Tantisattamo, Ekamol / Kalantar-Zadeh, Kamyar

    Current opinion in nephrology and hypertension

    2020  Volume 30, Issue 1, Page(s) 1–4

    MeSH term(s) COVID-19 ; Cardiovascular Diseases/etiology ; Diabetes Complications/complications ; Forecasting ; Humans ; Kidney ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/therapy ; Kidney Transplantation/adverse effects ; Obesity/complications ; Pandemics ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy ; SARS-CoV-2 ; Uremia/therapy
    Language English
    Publishing date 2020-11-11
    Publishing country England
    Document type Editorial ; Introductory Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000677
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    Zs.A 3686: Show issues Location:
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  4. Article ; Online: Novel dietary and pharmacologic approaches for acid-base modulation to preserve kidney function and manage uremia.

    Goraya, Nimrit / Wesson, Donald E

    Current opinion in nephrology and hypertension

    2019  Volume 29, Issue 1, Page(s) 39–48

    Abstract: Purpose of review: We review mechanisms for chronic kidney disease (CKD) progression that might be addressed with nonpharmacologic and novel pharmacologic interventions as strategies by which to slow or even prevent CKD progression.: Recent findings: ...

    Abstract Purpose of review: We review mechanisms for chronic kidney disease (CKD) progression that might be addressed with nonpharmacologic and novel pharmacologic interventions as strategies by which to slow or even prevent CKD progression.
    Recent findings: Evolving data support the contribution of the broad spectrum of disorders of acid (H) accumulation, which we refer to as 'H stress', to CKD progression. Recent studies support that amelioration of H stress, including spectra of H accumulation that are insufficient to cause metabolic acidosis, is kidney-protective. In addition, gut-derived toxins appear to contribute to CKD progression and to the well described increased cardiovascular disease (CVD) risk in patients with CKD. Dietary and novel pharmacologic interventions hold promise as strategies to slow CKD progression through reducing levels of these gut-derived toxins. In addition, oxidative stress appears to mediate CKD progression and contributing factors like diet and cigarette smoking can exacerbate oxidative stress. Dietary changes and smoking cessation hold promise to favorably affect CKD progression by reducing kidney oxidative stress.
    Summary: The urgent need to add to the traditional armamentarium of blood pressure control and antiangiotensin II pharmacologic therapy for kidney protection has led to investigations into additional kidney-protective strategies. Acid stress, a disordered gut microbiome, and oxidative stress each appear to contribute to CKD progression and can be potentially addressed by nonpharmacologic and novel pharmacologic interventions.
    MeSH term(s) Acid-Base Equilibrium/drug effects ; Angiotensin Receptor Antagonists/therapeutic use ; Diet ; Gastrointestinal Microbiome ; Humans ; Kidney/drug effects ; Kidney/metabolism ; Oxidative Stress ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/metabolism ; Uremia/metabolism ; Uremia/therapy
    Chemical Substances Angiotensin Receptor Antagonists
    Language English
    Publishing date 2019-11-14
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1151092-4
    ISSN 1473-6543 ; 1535-3842 ; 1062-4813 ; 1062-4821
    ISSN (online) 1473-6543 ; 1535-3842
    ISSN 1062-4813 ; 1062-4821
    DOI 10.1097/MNH.0000000000000568
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Novel Approaches for the Removal of Uremic Solutes.

    Tang, Mengyao / Kalim, Sahir

    Clinical journal of the American Society of Nephrology : CJASN

    2022  Volume 17, Issue 8, Page(s) 1113–1115

    MeSH term(s) Charcoal ; Dialysis Solutions ; Humans ; Renal Dialysis ; Uremia/therapy
    Chemical Substances Dialysis Solutions ; Charcoal (16291-96-6)
    Language English
    Publishing date 2022-07-14
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 2226665-3
    ISSN 1555-905X ; 1555-9041
    ISSN (online) 1555-905X
    ISSN 1555-9041
    DOI 10.2215/CJN.06860622
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    Zs.A 6584: Show issues Location:
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  6. Article: Chronic systemic inflammation in uremia: potential therapeutic approaches.

    Guarnieri, Gianfranco / Biolo, Gianni / Zanetti, Michela / Barazzoni, Rocco

    Seminars in nephrology

    2004  Volume 24, Issue 5, Page(s) 441–445

    Abstract: ... therapeutic approaches. ... Systemic inflammation characterizes several chronic diseases including uremia. Inflammation ... for use of anti-inflammatory treatments in uremia. The current article describes the association between ...

    Abstract Systemic inflammation characterizes several chronic diseases including uremia. Inflammation may contribute to morbidity and mortality by enhancing protein-calorie malnutrition, infectious complications, and atherosclerosis and cardiovascular disease. Although inflammation in renal disease can be caused, at least in part, by reduced renal clearance of proinflammatory mediators (tumor necrosis factor [TNF]-alpha, interleukin [IL]-6), several pathogenetic mechanisms are likely to contribute to direct activation of the inflammatory process under these conditions. These mechanisms include accumulation of advance glycoxidation end products, production of reactive oxygen species and oxidative damage, and chronic infection. Support for direct activation of systemic inflammation provides a strong rationale for use of anti-inflammatory treatments in uremia. The current article describes the association between uremia and inflammation, provides evidence for activation of inflammatory process, and provides potential therapeutic approaches.
    MeSH term(s) Chronic Disease ; Humans ; Inflammation/drug therapy ; Inflammation/etiology ; Uremia/complications
    Language English
    Publishing date 2004-09-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 604652-6
    ISSN 1558-4488 ; 0270-9295
    ISSN (online) 1558-4488
    ISSN 0270-9295
    DOI 10.1016/j.semnephrol.2004.06.007
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  7. Article ; Online: Aggressive approach in a case of cancer cervix with uremia.

    Janaki, Mg / Mukesh, S / Arul Ponni, Tr / Nirmala, S

    Indian journal of palliative care

    2010  Volume 16, Issue 1, Page(s) 52–53

    Abstract: Carcinoma of cervix is the most common cancer in developing countries. Majority of them present in locally advanced stages. A 36-year-old lady presented with bleeding and white discharge per vagina since four months, vomiting and reduced urine output ... ...

    Abstract Carcinoma of cervix is the most common cancer in developing countries. Majority of them present in locally advanced stages. A 36-year-old lady presented with bleeding and white discharge per vagina since four months, vomiting and reduced urine output since two weeks. Patient had an exophytic cervical growth. Investigation revealed elevated serum creatinine. Patient received single fraction radiation and underwent percutaneous nephrostomy. At one month follow-up, serum creatinine returned to almost normal level. Patient underwent bilateral ante grade stenting and completed concurrent chemoradiotherapy. In selected subsets of patients, aggressive management offered longer palliation and good quality of life.
    Language English
    Publishing date 2010-02-28
    Publishing country United States
    Document type Case Reports
    ISSN 1998-3735
    ISSN (online) 1998-3735
    DOI 10.4103/0973-1075.63136
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Adsorption- and Displacement-Based Approaches for the Removal of Protein-Bound Uremic Toxins.

    Rodrigues, Flávia S C / Faria, Mónica

    Toxins

    2023  Volume 15, Issue 2

    Abstract: ... In this review, we describe adsorption- and displacement-based approaches currently being studied to enhance ...

    Abstract End-stage renal disease (ESRD) patients rely on renal replacement therapies to survive. Hemodialysis (HD), the most widely applied treatment, is responsible for the removal of excess fluid and uremic toxins (UTs) from blood, particularly those with low molecular weight (MW < 500 Da). The development of high-flux membranes and more efficient treatment modes, such as hemodiafiltration, have resulted in improved removal rates of UTs in the middle molecular weight range. However, the concentrations of protein-bound uremic toxins (PBUTs) remain essentially untouched. Due to the high binding affinity to large proteins, such as albumin, PBUTs form large complexes (MW > 66 kDa) which are not removed during HD and their accumulation has been strongly associated with the increased morbidity and mortality of patients with ESRD. In this review, we describe adsorption- and displacement-based approaches currently being studied to enhance the removal of PBUTs. The development of mixed matrix membranes (MMMs) with selective adsorption properties, infusion of compounds capable of displacing UTs from their binding site on albumin, and competitive binding membranes show promising results, but the road to clinical application is still long, and further investigation is required.
    MeSH term(s) Humans ; Uremic Toxins ; Uremia/metabolism ; Adsorption ; Protein Binding ; Toxins, Biological/metabolism ; Renal Dialysis/methods ; Kidney Failure, Chronic ; Albumins/metabolism
    Chemical Substances Uremic Toxins ; Toxins, Biological ; Albumins
    Language English
    Publishing date 2023-01-28
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2518395-3
    ISSN 2072-6651 ; 2072-6651
    ISSN (online) 2072-6651
    ISSN 2072-6651
    DOI 10.3390/toxins15020110
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  9. Article ; Online: NFκB in the development of endothelial activation and damage in uremia: an in vitro approach.

    Caballo, Carolina / Palomo, Marta / Cases, Aleix / Galán, Ana M / Molina, Patricia / Vera, Manel / Bosch, Xavier / Escolar, Gines / Diaz-Ricart, Maribel

    PloS one

    2012  Volume 7, Issue 8, Page(s) e43374

    Abstract: Impaired hemostasis coexists with accelerated atherosclerosis in patients with chronic kidney disease (CKD). The elevated frequency of atherothrombotic events has been associated with endothelial dysfunction. The relative contribution of the uremic state ...

    Abstract Impaired hemostasis coexists with accelerated atherosclerosis in patients with chronic kidney disease (CKD). The elevated frequency of atherothrombotic events has been associated with endothelial dysfunction. The relative contribution of the uremic state and the impact of the renal replacement therapies have been often disregarded. Plasma markers of endothelial activation and damage were evaluated in three groups of patients with CKD: under conservative treatment (predialysis), on hemodialysis, and on peritoneal dialysis. Activation of p38 MAPK and the transcription factor NFκB was assessed in endothelial cell (EC) cultures exposed to pooled sera from each group of patients. Most of the markers evaluated (VCAM-1, ICAM-1, VWF, circulating endothelial cells) were significantly higher in CDK patients than in controls, being significantly more increased in the group of peritoneal dialysis patients. These results correlated with the activation of both p38 MAPK and NFκB in EC cells exposed to the same sera samples, and also to the peritoneal dialysis fluids. Hemodialysis did not further contribute to the endothelial damage induced by the uremic state observed in predialysis patients, probably due to the improved biocompatibility of the hemodialysis technique in recent years, resulting in lower cellular activation. However, peritoneal dialysis seemed to exert a significant proinflammatory effect on the endothelium that could be related to the high glucose concentrations and glucose degradation products present in the dialysis fluid. Although peritoneal dialysis has been traditionally considered a more physiological technique, our results raise some doubts with respect to inflammation and EC damage.
    MeSH term(s) Aged ; E-Selectin/blood ; Endothelium, Vascular/metabolism ; Endothelium, Vascular/pathology ; Female ; Humans ; Intercellular Adhesion Molecule-1/blood ; Male ; Middle Aged ; NF-kappa B/blood ; NF-kappa B/metabolism ; P-Selectin/blood ; Platelet Endothelial Cell Adhesion Molecule-1/blood ; Uremia/blood ; Uremia/metabolism ; Uremia/pathology ; Vascular Cell Adhesion Molecule-1/blood
    Chemical Substances E-Selectin ; NF-kappa B ; P-Selectin ; Platelet Endothelial Cell Adhesion Molecule-1 ; Vascular Cell Adhesion Molecule-1 ; Intercellular Adhesion Molecule-1 (126547-89-5)
    Language English
    Publishing date 2012-08-22
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0043374
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  10. Article ; Online: Innovations in approaches to remove uraemic toxins.

    Masereeuw, Rosalinde / Verhaar, Marianne C

    Nature reviews. Nephrology

    2020  Volume 16, Issue 10, Page(s) 552–553

    MeSH term(s) Humans ; Inventions ; Renal Dialysis/instrumentation ; Renal Dialysis/methods ; Renal Insufficiency/therapy ; Renal Replacement Therapy/instrumentation ; Renal Replacement Therapy/methods ; Uremia/therapy
    Language English
    Publishing date 2020-05-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2490366-8
    ISSN 1759-507X ; 1759-5061
    ISSN (online) 1759-507X
    ISSN 1759-5061
    DOI 10.1038/s41581-020-0299-0
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