Accumulation of indoxyl-beta-D-glucuronide in uremic serum: suppression of its production by oral sorbent and efficient removal by hemodialysis.

Abstract

We identified and quantified indoxyl-beta-D-glucuronide in uremic serum and urine to determine the metabolism of indoles including indoxyl sulfate in uremic patients. Serum levels of indoxyl-beta-D-glucuronide were markedly increased in undialyzed uremic patients, in patients on hemodialysis, and in patients on continuous ambulatory peritoneal dialysis. Urinary excretion of indoxyl-beta-D-glucuronide was also increased in undialyzed uremic patients. Urinary indoxyl-beta-D-glucuronide was significantly correlated with serum indoxyl sulfate, indicating that a high serum level of indoxyl sulfate leads to the enhanced synthesis of indoxyl-beta-D-glucuronide. Oral sorbent (AST-120) administration markedly decreased the serum and urine levels of indoxyl-beta-D-glucuronide as well as indoxyl sulfate in the undialyzed uremic patients. Serum indoxyl-beta-D-glucuronide could be efficiently removed by hemodialysis despite its high protein-binding ratio of about 50%. In conclusion, the serum level of indoxyl-beta-D-glucuronide increases in uremic patients due to renal insufficiency and its increased production. The production of indoxyl-beta-D-glucuronide can be suppressed by oral sorbent treatment, and serum indoxyl-beta-D-glucuronide can be efficiently removed by hemodialysis.

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@article{Niwa1996AccumulationOI, title={Accumulation of indoxyl-beta-D-glucuronide in uremic serum: suppression of its production by oral sorbent and efficient removal by hemodialysis.}, author={Toshimitsu Niwa and Takuro Miyazaki and Saori Tsukushi and K-I Maeda and Yoshiharu Tsubakihara and Akira Owada and Tatsuo Shiigai}, journal={Nephron}, year={1996}, volume={74 1}, pages={72-8} }