Protein-bound uremic toxins - biological effects and impact on morbidity in patients with chronic kidney disease.

Cardiovascular complications are the main cause of increased mortality in patients with chronic kidney disease. Besides traditional risk factors, accumulated uremic toxins contribute to the accelerated atherosclerosis, which is accompanied by the progression of chronic kidney disease. Increased clearance of toxins with low molecular weight does not significantly improve survival of hemodialysis patients, and therefore the role and influence of other toxins, including protein-bound solutes (PBS) is intensively investigated. In our work, PBS is discussed on the example of indoxyl sulphate and pcresol sulphate. These substances are highly bound to proteins and removed from the circulation during dialysis to a small extent only. In our article, pathophysiological effects, the impact on the progression of chronic kidney disease and the survival of patients were discussed. We also assessed available methods of removing toxins from the system.