Uremic Toxicity: Present State of the Art

The uremic syndrome is a complex mixture of organ dysfunctions, which is attributed to the retention of a myriad of compounds that under normal condition are excreted by the healthy kidneys (uremic toxins). In the area of identification and characterization of uremic toxins and in the knowledge of their pathophysiologic importance, major steps forward have been made during recent years. The present article is a review of several of these steps, especially in the area of information about the compounds that could play a role in the development of cardiovascular complications. It is written by those members of the Uremic Toxins Group, which has been created by the European Society for Artificial Organs (ESAO). Each of the 16 authors has written a state of the art in his/her major area of interest.

Ethylene Glycol Dimethacrylate Cross-linking Anion Exchange Resin as Phosphate Binder: Effects on Rat gut and Digestion by Small Intestine Contents

In the present study, ethylene glycol dimethacrylate cross-linking 4-vinylpyridinium anion exchange resin (EGDMA-4VP) effectively bound dietary phosphate in normal rats. However, EGDMA-4VP induced more adverse effects in rat gut than cellulose or Dowex 1X2 (both of which have higher water content), and caused damage to the intestine. In order to resolve this seeming paradox, digestion of EGDMA-4VP with rat small intestine content (S-9 fraction) and carboxyl esterase was investigated in vitro to examine the stability of the resin under conditions it would be subjected to as an orally administered medicine. EGDMA-4VP was digested by small intestinal enzymes, with the exception of carboxyl esterase, and the degradation product ethylene glycol (EG) caused reversible relaxation of longitudinal muscle (but not circular muscle) in rat small intestine. Degradation products increased uptake of3H2O into primary cultured rat small intestinal muscle cells, but the increase was not significant.