In end-stage renal disease urea as well as other solutes may accumulate. Some solutes such as urea are readily dialyzable while others are not. The presence of these poorly dialyzable solutes ("uremic toxins") can result in the "residual syndrome".
Factors contributing to retention of solutes during dialysis:
(1) distribution into multiple body compartments
(2) protein binding
(3) large size
(4) production by colonic microbes
As many as 500 compounds may be involved (Meyer and Hostetter). These include:
(1) p-cresol sulfate
(2) indoxyl sulfate
Feaures of the residual syndrome:
(1) end-stage renal disease
(2) adequate dialysis
(3) persistence of uremic symptoms
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