Abstract:

【Abstract】: Cardiovascular disease (CVD), the most common complication for chronic kidney disease, especially in patients with end-stage renal disease, but also is the leading cause of death. Recently, the protein-bound uremic toxins have been demonstrated that closely interrelated with cardiovascular mortality in CKD and/or dialysis patients. The protein-bound uremic toxins, the uremic toxics combined with albumin, most of them have an molecular weight （MW）＞500 Da，which are poorly removed by currently standard dialysis strategies, may lead to the great change of the protein molecular structure itself, or even the function and the electricity, as well as injures to other organs or systems. More and more studies have demonstrated that the protein-bound uremic toxins, especially homocysteine, indoxyl sulfate and p-cresyl sulfate induce endothelial dysfunction and leukocyte activation, causing high oxidative stress. They also adversely affect the interaction between leukocytes and endothelium. Vascular smooth muscle cell (VSMC) proliferation, increased risk of atherosclerosis, and cardiac fibrosis may together explain the cardiovascular and renal toxicity of these protein-bound uremic toxins.