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New elements in the role of uremic toxins in the arteriosclerosis

Raymond Vanholder
University Hospital Ghent, Belgium
 MAY 11th SYMPOSIUM 5 - HALL K1/K2 11:30 - 12:30

Cardio-vascular disease is one of the major causes of morbidity and mortality of any stage of chronic kidney disease (CKD). When kidney function fails, a host of compounds is retained in the body, which under normal conditions are secreted in the urine; Many of these compounds have the potential to cause vascular damage and hence to contribute to cardio-vascular damage. The European Uremic Toxin Work Group (EUTox) is a Consortium of European research institutes, evaluating and identifying potential culprits for functional disturbances occurring in CKD (uremic toxicity), and is the body organizing this Workshop. New information regarding compounds playing a role in vascular damage during CKD will be displayed, as well as therapeutic options to counter their effects. Several solutes will be discussed: 1) the guanidines, among which symmetric dimethylarginine (SDMA) enhancing leukocyte functional capacity and asymmetric dimethylarginine (ADMA) increasing intima-media thickness; 2) the protein-bound compounds, among which p-cresylsulfate, causing leukocyte activation, and indoxyl sulfate, provoking endothelial damage;  3) B2-microglobulin, linked to mortality and atherosclerosis. We also propose some therapeutic measures to counteract these effects and/or to remove these compounds: for (1), inhibition of cellular calcium influx and of NFkB; for (2), post-dilution on-line hemodiafiltration; for (3) high-flux hemodialysis; for (1) and (4), increase in dialysis length.