ArticleScientific reports2019
In silico comparison of protein-bound uremic toxin removal by hemodialysis, hemodiafiltration, membrane adsorption, and binding competition.
Article in Scientific reports, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Who cites it
21 citing papers in PubMed, 34 citations in OpenAlex.
- Comparing Ibuprofen and Loop Diuretics for Protein-Bound Uremic Toxins Clearance During Hemodialysis.Kidney international reports · 2026Article
- Targeting Uremic Toxins in Chronic Kidney Disease: Current Challenges and Emerging Therapeutic Strategies.Toxins · 2026Review
- Hemodiafiltration beyond the CONVINCE trial.Clinical kidney journal · 2026Review
- Membrane-to-Patient Optimization: Individualized Dialyzer Selection for Extracorporeal Dialysis.Toxins · 2026Review
- Review
- Optimization of Ibuprofen Route and Dosage to Enhance Protein-Bound Uremic Toxin Clearance During Hemodialysis.Toxins · 2026Article
- Associations Between Renal Function, Uremic Toxins, and Cognitive Performance in Patients with Chronic Kidney Disease: A Pilot Study.International journal of medical sciences · 2026Observational
- Next- Gen Detox: Nanoparticles strategies for liver and kidney toxin removal.Toxicology research · 2025Review
- Loop diuretics in anuric hemodialysis patients for the clearance of protein-bound uremic toxins.Clinical kidney journal · 2025Article
- The Choice of Anti-Inflammatory Influences the Elimination of Protein-Bound Uremic Toxins.Toxins · 2024Article
- Displacing the Burden: A Review of Protein-Bound Uremic Toxin Clearance Strategies in Chronic Kidney Disease.Journal of clinical medicine · 2024Review
- Effect of Membrane Permeance and System Parameters on the Removal of Protein-Bound Uremic Toxins in Hemodialysis.Annals of biomedical engineering · 2024Article
- Case report: therapeutic monitoring of vancomycin in an acute liver failure patient with anuria under high-flow continuous hemodiafiltration.Journal of pharmaceutical health care and sciences · 2023Article
- Research progress on the relationship between IS and kidney disease and its complications.International urology and nephrology · 2022Review
- Improved Dialysis Removal of Protein-Bound Uraemic Toxins with a Combined Displacement and Adsorption Technique.Blood purification · 2022Article
- Chronic kidney disease and neurological disorders: are uraemic toxins the missing piece of the puzzle?Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2021Review
- Article
- The membrane perspective of uraemic toxins: which ones should, or can, be removed?Clinical kidney journal · 2021Review
- Removal of Protein-Bound Uremic Toxins Using Binding Competitors in Hemodialysis: A Narrative Review.Toxins · 2021Review
- Multi-scale modeling of drug binding kinetics to predict drug efficacy.Cellular and molecular life sciences : CMLS · 2020Review
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Protein-bound uremic toxins (PBUTs) are poorly removed during hemodialysis (HD) due to their low free (dialyzable) plasma concentration. We compared PBUT removal between HD, hemodiafiltration (HDF), membrane adsorption, and PBUT displacement in HD. The latter involves infusing a binding competitor pre-dialyzer, which competes with PBUTs for their albumin binding sites and increases their free fraction. We used a mathematical model of PBUT/displacer kinetics in dialysis comprising a three-compartment patient model, an arterial/venous tube segment model, and a dialyzer model. Compared to HD, improvements in removal of prototypical PBUTs indoxyl sulfate (initial concentration 100 µM, 7% free) and p-cresyl sulfate (150 µM, 5% free) were: 5.5% and 6.4%, respectively, for pre-dilution HDF with 20 L replacement fluid; 8.1% and 9.1% for post-dilution HDF 20 L; 15.6% and 18.3% for pre-dilution HDF 60 L; 19.4% and 22.2% for complete membrane adsorption; 35.0% and 41.9% for displacement with tryptophan (2000 mg in 500 mL saline); 26.7% and 32.4% for displacement with ibuprofen (800 mg in 200 mL saline). Prolonged (one-month) use of tryptophan reduces the IS and pCS time-averaged concentration by 28.1% and 29.9%, respectively, compared to conventional HD. We conclude that competitive binding can be a pragmatic approach for improving PBUT removal.
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