Show simple item record

Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

dc.contributor.authorAdamasco Cupisti
dc.contributor.authorPiergiorgio Bolasco
dc.contributor.authorClaudia D’Alessandro
dc.contributor.authorDomenico Giannese
dc.contributor.authorAlice Sabatino
dc.contributor.authorEnrico Fiaccadori
dc.contributor.otherDepartment of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
dc.contributor.other“Conservative Treatment of Chronic Kidney Disease” Project Group of the Italian Society of Nephrology, 00185 Rome, Italy
dc.contributor.otherDepartment of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
dc.contributor.otherDepartment of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy
dc.contributor.otherDepartment of Medicine and Surgery, University of Parma, Nephrology Unit, Parma University Hospital, 43121 Parma, Italy
dc.contributor.otherDepartment of Medicine and Surgery, University of Parma, Nephrology Unit, Parma University Hospital, 43121 Parma, Italy
dc.date.accessioned2025-10-09T05:24:32Z
dc.date.available2025-10-09T05:24:32Z
dc.date.issued01-04-2021
dc.identifier.urihttps://www.mdpi.com/2072-6651/13/4/289
dc.identifier.urihttp://digilib.fisipol.ugm.ac.id/repo/handle/15717717/40997
dc.description.abstractThe retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.
dc.language.isoEN
dc.publisherMDPI AG
dc.subject.lccMedicine
dc.titleProtection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients
dc.typeArticle
dc.description.keywordsuremic toxins
dc.description.keywordsnutrition
dc.description.keywordsinfrequent dialysis
dc.description.keywordsdietary protein
dc.description.keywordsnutritional therapy
dc.description.keywordsresidual kidney function
dc.description.doi10.3390/toxins13040289
dc.title.journalToxins
dc.identifier.e-issn2072-6651
dc.identifier.oaioai:doaj.org/journal:44082e35936a493ab8fc408db834cbd8
dc.journal.infoVolume 13, Issue 4


This item appears in the following Collection(s)

Show simple item record