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J Am Soc Nephrol 13:S41-S47, 2002
© 2002 American Society of Nephrology

Renal Replacement Therapy

Low-Molecular Weight Proteins in End-Stage Renal Disease: Potential Toxicity and Dialytic Removal Mechanisms

William R. Clark*{dagger} and Dayong Gao{ddagger}

*Renal Division, Baxter Healthcare Corporation, McGaw Park, Indiana; {dagger}Nephrology Division, Indiana University School of Medicine, Indianapolis, Indiana; and {ddagger}Center for Biomedical Engineering, University of Kentucky, Lexington, Kentucky.

Address correspondence to Dr. William R. Clark, Hemodialysis Research Laboratory, Renal Division, Baxter Healthcare Corporation, Wishard Hospital/Myers Building D711, 1001 West 10th Street, Indianapolis, IN 46202. Phone: 317-613-2315, ext. 327; Fax: 317-613-2317; E-mail: clarkbi{at}baxter.com

Abstract

ABSTRACT. Low-molecular-weight proteins (LMWP) are now recognized as a distinct class of uremic toxins, and numerous compounds in this category have been identified. Dr. Henderson has spent much of his career investigating ways to enhance the removal of intermediate- and large-sized uremic retention molecules. As LMWP clearly fall under this category, it is fitting to provide a review of several aspects of this molecular class. Normal renal metabolism of LMWP is discussed along with the changes that occur during chronic renal insufficiency. The effect of end-stage renal disease on plasma LMWP concentrations is assessed. As examples of the potential uremic toxicity of this molecular class, leptin, adrenomedullin, and the compounds associated with increased susceptibility to infection are highlighted. Finally, an overview of LMWP removal mechanisms for both hemodialysis and the convective therapies is provided.




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