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Uremic toxins

Raymond Vanholder, MD, PhD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


The uremic syndrome can be defined as the deterioration of multiple biochemical and physiological functions in parallel with progressive renal failure, thereby resulting in complex but variable symptomatology [1-7]. Normally, healthy kidneys excrete a myriad of compounds. Uremic retention solutes accumulate in the patient with chronic kidney disease (CKD), including the patient with Kidney Disease Outcomes Quality Initiative (KDOQI) stage 5 disease or end-stage renal disease (ESRD) [8]. The retention of these solutes is directly or indirectly attributable to deficient renal clearance.

These retained solutes are called uremic toxins when they contribute to the uremic syndrome. Only a few solutes have an established role. Apart from inorganic compounds, only a few compounds conform to the strictest definition of uremic toxins. However, this does not preclude a potential role for various other retention solutes. (See "Overview of the management of chronic kidney disease in adults".)

Uremic toxins can be subdivided into three major groups based upon their chemical and physical characteristics:

Small, water-soluble, non-protein-bound compounds, such as urea

Small, lipid-soluble and/or protein-bound compounds, such as the phenols

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Literature review current through: Sep 2017. | This topic last updated: Sep 18, 2017.
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