Review of protein-bound toxins, possibility for blood purification therapy

Blood Purif. 2013;35 Suppl 1:45-50. doi: 10.1159/000346223. Epub 2013 Feb 25.


Protein-bound uremic retention solutes, i.e. phenolic compounds, such as p-cresylsulfate, and indolic compounds, such as indoxyl sulfate, have been intensively studied in recent years and have been shown to be associated especially with cardiovascular toxicity and adverse outcomes in chronic kidney disease. In this review, we will focus on their toxicity and their removal by dialysis strategies, which is hampered due to their protein binding. Hemodiafiltration slightly improves the removal of protein-bound solutes as compared to hemodialysis, although the clinical benefit on outcomes still needs to be demonstrated. Removal by means of absorption and interference with intestinal generation or renal tubular excretion are interesting alternative strategies under investigation.

Publication types

  • Review

MeSH terms

  • Blood Proteins / metabolism
  • Hemodiafiltration* / methods
  • Humans
  • Intestinal Mucosa / metabolism
  • Protein Binding
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / therapy
  • Uremia / blood*
  • Uremia / etiology
  • Uremia / therapy*


  • Blood Proteins