{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:07:57Z","timestamp":1790842077926,"version":"4.1.0"},"reference-count":93,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Chronic kidney disease (CKD) is a highly prevalent condition and is associated with a high comorbidity burden, polymedication, and a high mortality rate. A number of conventional and nonconventional risk factors for comorbidities and mortality in CKD have been identified. Among the nonconventional risk factors, uremic toxins are valuable therapeutic targets. The fact that some uremic toxins are gut-derived suggests that intestinal chelators might have a therapeutic effect. The phosphate binders used to prevent hyperphosphatemia in hemodialysis patients act by complexing inorganic phosphate in the gastrointestinal tract but might conceivably have a nonspecific action on gut-derived uremic toxins. Since phosphorous is a major nutrient for the survival and reproduction of bacteria, changes in its intestinal concentration may impact the gut microbiota\u2019s activity and composition. Furthermore, AST-120 is an orally administered activated charcoal adsorbent that is widely used in Asian countries to specifically decrease uremic toxin levels. In this narrative review, we examine the latest data on the use of oral nonspecific and specific intestinal chelators to reduce levels of gut-derived uremic toxins.<\/jats:p>","DOI":"10.3390\/toxins13020091","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T08:29:16Z","timestamp":1611649756000},"page":"91","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Intestinal Chelators, Sorbants, and Gut-Derived Uremic Toxins"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0214-5567","authenticated-orcid":false,"given":"Sol\u00e8ne M.","family":"Laville","sequence":"first","affiliation":[{"name":"Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Universit\u00e9 Paris-Saclay, F-94807 Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziad A.","family":"Massy","sequence":"additional","affiliation":[{"name":"Centre for Research in Epidemiology and Population Health (CESP), INSERM UMRS 1018, Universit\u00e9 Paris-Saclay, F-94807 Villejuif, France"},{"name":"Department of Nephrology, Ambroise Par\u00e9 University Hospital, APHP, Boulogne Billancourt, F-92100 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Kamel","sequence":"additional","affiliation":[{"name":"MP3CV Laboratory, EA7517, Jules Verne University of Picardie, F-80000 Amiens, France"},{"name":"Department of Biochemistry, Amiens University Medical Center, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1610-9935","authenticated-orcid":false,"given":"Jean Marc","family":"Chillon","sequence":"additional","affiliation":[{"name":"MP3CV Laboratory, EA7517, Jules Verne University of Picardie, F-80000 Amiens, France"},{"name":"Direction of Clinical Research, Amiens University Medical Center, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Choukroun","sequence":"additional","affiliation":[{"name":"MP3CV Laboratory, EA7517, Jules Verne University of Picardie, F-80000 Amiens, France"},{"name":"Department of Nephrology Dialysis Transplantation, Amiens University Medical Center, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5384-9006","authenticated-orcid":false,"given":"Sophie","family":"Liabeuf","sequence":"additional","affiliation":[{"name":"MP3CV Laboratory, EA7517, Jules Verne University of Picardie, F-80000 Amiens, France"},{"name":"Direction of Clinical Research, Amiens University Medical Center, F-80000 Amiens, France"},{"name":"Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.1016\/S0140-6736(17)30788-2","article-title":"Global Kidney Health 2017 and beyond: A Roadmap for Closing Gaps in Care, Research, and Policy","volume":"390","author":"Levin","year":"2017","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e184852","DOI":"10.1001\/jamanetworkopen.2018.4852","article-title":"Comparison of the Complexity of Patients Seen by Different Medical Subspecialists in a Universal Health Care System","volume":"1","author":"Tonelli","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Vanholder, R., Pletinck, A., Schepers, E., and Glorieux, G. (2018). Biochemical and Clinical Impact of Organic Uremic Retention Solutes: A Comprehensive Update. Toxins, 10.","DOI":"10.3390\/toxins10010033"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Six, I., Flissi, N., Lenglet, G., Louvet, L., Kamel, S., Gallet, M., Massy, Z.A., and Liabeuf, S. (2020). Uremic Toxins and Vascular Dysfunction. Toxins, 12.","DOI":"10.3390\/toxins12060404"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Hayward, S., Hole, B., Denholm, R., Duncan, P., Morris, J.E., Fraser, S.D.S., Payne, R.A., Roderick, P., Chesnaye, N.C., and Wanner, C. (2020). International Prescribing Patterns and Polypharmacy in Older People with Advanced Chronic Kidney Disease: Results from the European Quality Study. Nephrol. Dial. Transpl.","DOI":"10.1093\/ndt\/gfaa064"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Liabeuf, S., and Laville, M. (2020). Drug Prescription in Patients with Chronic Kidney Disease: A True Challenge. Nephrol. Dial. Transpl.","DOI":"10.1093\/ndt\/gfaa164"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1046\/j.1523-1755.2003.00924.x","article-title":"Review on Uremic Toxins: Classification, Concentration, and Interindividual Variability","volume":"63","author":"Vanholder","year":"2003","journal-title":"Kidney Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.tem.2016.10.005","article-title":"Trimethylamine-N-Oxide: Friend, Foe, or Simply Caught in the Cross-Fire?","volume":"28","author":"Cho","year":"2017","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1111\/bph.13959","article-title":"Trimethylamine N-Oxide: Breathe New Life","volume":"175","author":"Subramaniam","year":"2018","journal-title":"Br. J. Pharm."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1056\/NEJMoa1109400","article-title":"Intestinal Microbial Metabolism of Phosphatidylcholine and Cardiovascular Risk","volume":"368","author":"Tang","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.kint.2017.03.053","article-title":"The Role of Trimethylamine N-Oxide as a Mediator of Cardiovascular Complications in Chronic Kidney Disease","volume":"92","author":"Tomlinson","year":"2017","journal-title":"Kidney Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.kint.2016.01.014","article-title":"Advanced Chronic Kidney Disease Populations Have Elevated Trimethylamine N-Oxide Levels Associated with Increased Cardiovascular Events","volume":"89","author":"Kim","year":"2016","journal-title":"Kidney Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.2215\/CJN.03980609","article-title":"Serum Indoxyl Sulfate Is Associated with Vascular Disease and Mortality in Chronic Kidney Disease Patients","volume":"4","author":"Barreto","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"911","DOI":"10.3390\/toxins3070911","article-title":"Protein-Bound Uremic Toxins: New Insight from Clinical Studies","volume":"3","author":"Liabeuf","year":"2011","journal-title":"Toxins"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1681\/ASN.2013121283","article-title":"The Cardiovascular Effect of the Uremic Solute Indole-3 Acetic Acid","volume":"26","author":"Dou","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"934","DOI":"10.3390\/toxins6030934","article-title":"The Aryl Hydrocarbon Receptor-Activating Effect of Uremic Toxins from Tryptophan Metabolism: A New Concept to Understand Cardiovascular Complications of Chronic Kidney Disease","volume":"6","author":"Dou","year":"2014","journal-title":"Toxins"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gryp, T., Vanholder, R., Vaneechoutte, M., and Glorieux, G. (2017). P-Cresyl Sulfate. Toxins, 9.","DOI":"10.3390\/toxins9020052"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1093\/ndt\/gfp592","article-title":"Free P-Cresylsulphate Is a Predictor of Mortality in Patients at Different Stages of Chronic Kidney Disease","volume":"25","author":"Liabeuf","year":"2010","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1093\/ndt\/gfp414","article-title":"P-Cresyl Sulfate Serum Concentrations in Haemodialysis Patients Are Reduced by the Prebiotic Oligofructose-Enriched Inulin","volume":"25","author":"Meijers","year":"2010","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Di Iorio, B.R., Rocchetti, M.T., De Angelis, M., Cosola, C., Marzocco, S., Di Micco, L., di Bari, I., Accetturo, M., Vacca, M., and Gobbetti, M. (2019). Nutritional Therapy Modulates Intestinal Microbiota and Reduces Serum Levels of Total and Free Indoxyl Sulfate and P-Cresyl Sulfate in Chronic Kidney Disease (Medika Study). J. Clin. Med., 8.","DOI":"10.3390\/jcm8091424"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/hdi.12414","article-title":"Reduced Protein Bound Uraemic Toxins in Vegetarian Kidney Failure Patients Treated by Haemodiafiltration","volume":"20","author":"Kandouz","year":"2016","journal-title":"Hemodial. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.numecd.2015.03.015","article-title":"Dietary Protein-Fiber Ratio Associates with Circulating Levels of Indoxyl Sulfate and p-Cresyl Sulfate in Chronic Kidney Disease Patients","volume":"25","author":"Rossi","year":"2015","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"982","DOI":"10.2215\/CJN.12491211","article-title":"The Production of P-Cresol Sulfate and Indoxyl Sulfate in Vegetarians Versus Omnivores","volume":"7","author":"Patel","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Tomova, A., Bukovsky, I., Rembert, E., Yonas, W., Alwarith, J., Barnard, N.D., and Kahleova, H. (2019). The Effects of Vegetarian and Vegan Diets on Gut Microbiota. Front. Nutr., 6.","DOI":"10.3389\/fnut.2019.00047"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1053\/ajkd.1998.v31.pm9531176","article-title":"Association of Serum Phosphorus and Calcium x Phosphate Product with Mortality Risk in Chronic Hemodialysis Patients: A National Study","volume":"31","author":"Block","year":"1998","journal-title":"Am. J. Kidney Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chartsrisak, K., Vipattawat, K., Assanatham, M., Nongnuch, A., Ingsathit, A., Domrongkitchaiporn, S., Sumethkul, V., and Distha-Banchong, S. (2013). Mineral Metabolism and Outcomes in Chronic Kidney Disease Stage 2\u20134 Patients. BMC Nephrol., 14.","DOI":"10.1186\/1471-2369-14-14"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.2215\/CJN.00810110","article-title":"Serum Phosphate and Mortality in Patients with Chronic Kidney Disease","volume":"5","author":"Eddington","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1681\/ASN.2020081182","article-title":"Binder Blunder in CKD","volume":"31","author":"Ix","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1053\/j.ajkd.2016.05.015","article-title":"Phosphate-Binding Agents in Adults with CKD: A Network Meta-Analysis of Randomized Trials","volume":"68","author":"Palmer","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_30","first-page":"134","article-title":"Valvular Calcification in Hemodialysis Patients Randomized to Calcium-Based Phosphorus Binders or Sevelamer","volume":"13","author":"Raggi","year":"2004","journal-title":"J. Heart Valve Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.2215\/CJN.00290109","article-title":"Pill Burden, Adherence, Hyperphosphatemia, and Quality of Life in Maintenance Dialysis Patients","volume":"4","author":"Chiu","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1111\/hdi.12315","article-title":"Phosphate Binder Pill Burden, Patient-Reported Non-Adherence, and Mineral Bone Disorder Markers: Findings from the DOPPS","volume":"20","author":"Fissell","year":"2016","journal-title":"Hemodial. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1159\/000444421","article-title":"Calcium Acetate\/Magnesium Carbonate and Cardiovascular Risk Factors in Chronic Hemodialysis Patients","volume":"132","author":"Matias","year":"2016","journal-title":"Nephron"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1046\/j.1523-1755.2002.00434.x","article-title":"Treat to Goal Working Group Sevelamer Attenuates the Progression of Coronary and Aortic Calcification in Hemodialysis Patients","volume":"62","author":"Chertow","year":"2002","journal-title":"Kidney Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/ndt\/18.3.582","article-title":"Sevelamer Hydrochloride with or without Alphacalcidol or Higher Dialysate Calcium vs Calcium Carbonate in Dialysis Patients: An Open-Label, Randomized Study","volume":"18","author":"Sadek","year":"2003","journal-title":"Nephrol. Dial.Transplant."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1111\/j.1440-1797.2010.01412.x","article-title":"Attenuation of Aortic Calcification with Lanthanum Carbonate versus Calcium-Based Phosphate Binders in Haemodialysis: A Pilot Randomized Controlled Trial","volume":"16","author":"Toussaint","year":"2011","journal-title":"Nephrology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1007\/s00223-017-0347-3","article-title":"Effects of Lanthanum Carbonate on Coronary Artery Calcification and Cardiac Abnormalities After Initiating Hemodialysis","volume":"102","author":"Fujii","year":"2018","journal-title":"Calcif. Tissue Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"8877","DOI":"10.1038\/s41598-019-45335-4","article-title":"Randomised Clinical Trial of Ferric Citrate Hydrate on Anaemia Management in Haemodialysis Patients with Hyperphosphataemia: ASTRIO Study","volume":"9","author":"Yokoyama","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1681\/ASN.2014020212","article-title":"Ferric Citrate Controls Phosphorus and Delivers Iron in Patients on Dialysis","volume":"26","author":"Lewis","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1053\/j.jrn.2018.11.002","article-title":"One-Year Historical Cohort Study of the Phosphate Binder Sucroferric Oxyhydroxide in Patients on Maintenance Hemodialysis","volume":"29","author":"Kendrick","year":"2019","journal-title":"J. Ren. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"59","DOI":"10.5414\/CN109021","article-title":"Real-World Effectiveness of Sucroferric Oxyhydroxide in Patients on Chronic Hemodialysis: A Retrospective Analysis of Pharmacy Data","volume":"88","author":"Coyne","year":"2017","journal-title":"Clin. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1038\/ki.2014.58","article-title":"PA21 Study Group A Phase III Study of the Efficacy and Safety of a Novel Iron-Based Phosphate Binder in Dialysis Patients","volume":"86","author":"Floege","year":"2014","journal-title":"Kidney Int."},{"key":"ref_43","first-page":"1330","article-title":"Iron-Related Parameters in Dialysis Patients Treated with Sucroferric Oxyhydroxide","volume":"32","author":"Covic","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1815","DOI":"10.1111\/j.1523-1755.2005.00600.x","article-title":"Effects of Sevelamer and Calcium on Coronary Artery Calcification in Patients New to Hemodialysis","volume":"68","author":"Block","year":"2005","journal-title":"Kidney Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000447600","article-title":"Pharmacodynamic Effects of Sucroferric Oxyhydroxide and Sevelamer Carbonate on Vitamin D Receptor Agonist Bioactivity in Dialysis Patients","volume":"44","author":"Sprague","year":"2016","journal-title":"Am. J. Nephrol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00467-015-3269-1","article-title":"Sevelamer Crystals in the Mucosa of the Gastrointestinal Tract in a Teenager with End-Stage Renal Disease","volume":"31","author":"Kim","year":"2016","journal-title":"Pediatr. Nephrol."},{"key":"ref_47","first-page":"4708068","article-title":"Colonic Mucosal Ulceration and Gastrointestinal Bleeding Associated with Sevelamer Crystal Deposition in a Patient with End Stage Renal Disease","volume":"2018","author":"Nambiar","year":"2018","journal-title":"Case Rep. Nephrol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Tieu, C., Moreira, R.K., Song, L.M.W.K., Majumder, S., Papadakis, K.A., and Hogan, M.C. (2016). A Case Report of Sevelamer-Associated Recto-Sigmoid Ulcers. BMC Gastroenterol., 16.","DOI":"10.1186\/s12876-016-0441-4"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1007\/s12011-017-1235-4","article-title":"Lanthanum-Induced Mucosal Alterations in the Stomach (Lanthanum Gastropathy): A Comparative Study Using an Animal Model","volume":"185","author":"Yabuki","year":"2018","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.anndiagpath.2016.10.001","article-title":"Gastric Mucosal Status Susceptible to Lanthanum Deposition in Patients Treated with Dialysis and Lanthanum Carbonate","volume":"26","author":"Ban","year":"2017","journal-title":"Ann. Diagn. Pathol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/pin.12564","article-title":"Correlation of Lanthanum Dosage with Lanthanum Deposition in the Gastroduodenal Mucosa of Dialysis Patients","volume":"67","author":"Hattori","year":"2017","journal-title":"Pathol. Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1111\/his.13178","article-title":"Lanthanum Deposition from Oral Lanthanum Carbonate in the Upper Gastrointestinal Tract","volume":"70","author":"Hoda","year":"2017","journal-title":"Histopathology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1093\/ndt\/9.8.1121","article-title":"Calcium Acetate versus Calcium Carbonate as Phosphate-Binding Agents in Chronic Haemodialysis","volume":"9","author":"Pflanz","year":"1994","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1056\/NEJM200005183422003","article-title":"Coronary-Artery Calcification in Young Adults with End-Stage Renal Disease Who Are Undergoing Dialysis","volume":"342","author":"Goodman","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"(2017). Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. Suppl., 7, 1\u201359.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3707","DOI":"10.1093\/ndt\/gfq292","article-title":"Evaluation of Calcium Acetate\/Magnesium Carbonate as a Phosphate Binder Compared with Sevelamer Hydrochloride in Haemodialysis Patients: A Controlled Randomized Study (CALMAG Study) Assessing Efficacy and Tolerability","volume":"25","author":"Leidig","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1007\/s11255-014-0751-9","article-title":"Magnesium Retards the Progress of the Arterial Calcifications in Hemodialysis Patients: A Pilot Study","volume":"46","author":"Tzanakis","year":"2014","journal-title":"Int. Urol. Nephrol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"i52","DOI":"10.1093\/ndtplus\/sfr167","article-title":"Magnesium and Outcomes in Patients with Chronic Kidney Disease: Focus on Vascular Calcification, Atherosclerosis and Survival","volume":"5","author":"Massy","year":"2012","journal-title":"Clin. Kidney J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1038\/nrneph.2015.74","article-title":"Magnesium and Cardiovascular Complications of Chronic Kidney Disease","volume":"11","author":"Massy","year":"2015","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"232","DOI":"10.2215\/CJN.06800615","article-title":"Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials","volume":"11","author":"Patel","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1111\/j.1523-1755.2004.00590.x","article-title":"Treatment of Hyperphosphatemia in Hemodialysis Patients: The Calcium Acetate Renagel Evaluation (CARE Study)","volume":"65","author":"Qunibi","year":"2004","journal-title":"Kidney Int."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"252","DOI":"10.5414\/CNP72252","article-title":"Lanthanum Carbonate vs. Sevelamer Hydrochloride for the Reduction of Serum Phosphorus in Hemodialysis Patients: A Crossover Study","volume":"72","author":"Sprague","year":"2009","journal-title":"CN"},{"key":"ref_63","first-page":"286","article-title":"Lanthanum Carbonate Study Group Lanthanum Carbonate Treatment, for up to 6 Years, Is Not Associated with Adverse Effects on the Liver in Patients with Chronic Kidney Disease Stage 5 Receiving Hemodialysis","volume":"71","author":"Hutchison","year":"2009","journal-title":"Clin. Nephrol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1873","DOI":"10.1080\/14656566.2016.1220538","article-title":"Treating Hyperphosphatemia \u2013 Current and Advancing Drugs","volume":"17","author":"Ketteler","year":"2016","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/ckj\/sfu139","article-title":"Iron-Based Phosphate Binders: Do They Offer Advantages over Currently Available Phosphate Binders?","volume":"8","author":"Negri","year":"2015","journal-title":"Clin. Kidney J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.ekir.2019.06.002","article-title":"Strategies for Phosphate Control in Patients With CKD","volume":"4","author":"Barreto","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"543","DOI":"10.2215\/CJN.05170513","article-title":"Ferric Citrate Hydrate for the Treatment of Hyperphosphatemia in Nondialysis-Dependent CKD","volume":"9","author":"Yokoyama","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"2578","DOI":"10.1681\/ASN.2014080842","article-title":"Ferric Citrate Reduces Intravenous Iron and Erythropoiesis-Stimulating Agent Use in ESRD","volume":"26","author":"Umanath","year":"2015","journal-title":"JASN"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1038\/ki.2013.185","article-title":"Use of Phosphate-Binding Agents Is Associated with a Lower Risk of Mortality","volume":"84","author":"Locatelli","year":"2013","journal-title":"Kidney Int."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1016\/S0140-6736(13)60897-1","article-title":"Effect of Calcium-Based versus Non-Calcium-Based Phosphate Binders on Mortality in Patients with Chronic Kidney Disease: An Updated Systematic Review and Meta-Analysis","volume":"382","author":"Jamal","year":"2013","journal-title":"Lancet"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2653","DOI":"10.1681\/ASN.2020040411","article-title":"A Randomized Trial on the Effect of Phosphate Reduction on Vascular End Points in CKD (IMPROVE-CKD)","volume":"31","author":"Toussaint","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/joim.12508","article-title":"The Gut Microbiota and Metabolic Disease: Current Understanding and Future Perspectives","volume":"280","author":"Arora","year":"2016","journal-title":"J. Intern. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"172892","DOI":"10.1016\/j.ejphar.2019.172892","article-title":"Gut Microbiota; an Overlooked Effect of Phosphate Binders","volume":"868","author":"Niknafs","year":"2020","journal-title":"Eur. J. Pharmacol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1111\/sdi.12348","article-title":"Dietary Restrictions in Dialysis Patients: Is There Anything Left to Eat?","volume":"28","author":"Tortorici","year":"2015","journal-title":"Semin. Dial."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1124\/jpet.118.251389","article-title":"The Phosphate Binder Ferric Citrate Alters the Gut Microbiome in Rats with Chronic Kidney Disease","volume":"367","author":"Lau","year":"2018","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s10157-020-01892-x","article-title":"Effect of Sucroferric Oxyhydroxide on Gastrointestinal Microbiome and Uremic Toxins in Patients with Chronic Kidney Disease Undergoing Hemodialysis","volume":"24","author":"Iguchi","year":"2020","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_77","first-page":"505","article-title":"Sevelamer Hydrochloride (Renagel) Adsorbs Theuremic Compounds Indoxyl Sulfate, Indeole and p-Cresol","volume":"15","author":"Thermote","year":"2004","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Bennis, Y., Cluet, Y., Titeca-Beauport, D., El Esper, N., Ure\u00f1a, P., Bodeau, S., Combe, C., Dussol, B., Fouque, D., and Choukroun, G. (2019). The Effect of Sevelamer on Serum Levels of Gut-Derived Uremic Toxins: Results from In Vitro Experiments and A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial. Toxins, 11.","DOI":"10.3390\/toxins11050279"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2875","DOI":"10.1161\/CIRCULATIONAHA105.541854","article-title":"Sevelamer Prevents Uremia-Enhanced Atherosclerosis Progression in Apolipoprotein E-Deficient Mice","volume":"112","author":"Phan","year":"2005","journal-title":"Circulation"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Guida, B., Cataldi, M., Riccio, E., Grumetto, L., Pota, A., Borrelli, S., Memoli, A., Barbato, F., Argentino, G., and Salerno, G. (2013). Plasma P-Cresol Lowering Effect of Sevelamer in Peritoneal Dialysis Patients: Evidence from a Cross-Sectional Observational Study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0073558"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"765","DOI":"10.14740\/jocmr1803e","article-title":"Effects of Sevelamer Hydrochloride on Uremic Toxins Serum Indoxyl Sulfate and P-Cresyl Sulfate in Hemodialysis Patients","volume":"9","author":"Lin","year":"2017","journal-title":"J. Clin. Med. Res."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Dai, L., Meijers, B.K., Bammens, B., de Loor, H., Schurgers, L.J., Qureshi, A.R., Stenvinkel, P., and Evenepoel, P. (2020). Sevelamer Use in End-Stage Kidney Disease (ESKD) Patients Associates with Poor Vitamin K Status and High Levels of Gut-Derived Uremic Toxins: A Drug-Bug Interaction?. Toxins, 12.","DOI":"10.3390\/toxins12060351"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1093\/ndt\/gfq053","article-title":"Serological Cardiovascular and Mortality Risk Predictors in Dialysis Patients Receiving Sevelamer: A Prospective Study","volume":"25","author":"Brandenburg","year":"2010","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s10157-017-1504-8","article-title":"Plasma P-Cresol Lowering Effect of Sevelamer in Non-Dialysis CKD Patients: Evidence from a Randomized Controlled Trial","volume":"22","author":"Riccio","year":"2018","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s40265-019-01118-9","article-title":"Does the Administration of Sevelamer or Nicotinamide Modify Uremic Toxins or Endotoxemia in Chronic Hemodialysis Patients?","volume":"79","author":"Lenglet","year":"2019","journal-title":"Drugs"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1093\/ndt\/gfr056","article-title":"Warning: The Unfortunate End of p-Cresol as a Uraemic Toxin","volume":"26","author":"Vanholder","year":"2011","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/0886022X.2018.1561376","article-title":"Review of the Efficacy of AST-120 (KREMEZIN\u00ae) on Renal Function in Chronic Kidney Disease Patients","volume":"41","author":"Asai","year":"2019","journal-title":"Ren. Fail."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Bolati, D., Shimizu, H., Yisireyili, M., Nishijima, F., and Niwa, T. (2013). Indoxyl Sulfate, a Uremic Toxin, Downregulates Renal Expression of Nrf2 through Activation of NF-\u039aB. BMC Nephrol., 14.","DOI":"10.1186\/1471-2369-14-56"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.atherosclerosis.2015.09.019","article-title":"Deleterious Vascular Effects of Indoxyl Sulfate and Reversal by Oral Adsorbent AST-120","volume":"243","author":"Six","year":"2015","journal-title":"Atherosclerosis"},{"key":"ref_90","first-page":"S23","article-title":"The Protein Metabolite Hypothesis, a Model for the Progression of Renal Failure: An Oral Adsorbent Lowers Indoxyl Sulfate Levels in Undialyzed Uremic Patients","volume":"62","author":"Niwa","year":"1997","journal-title":"Kidney Int. Suppl."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"68","DOI":"10.23876\/j.krcp.2017.36.1.68","article-title":"Sustained Uremic Toxin Control Improves Renal and Cardiovascular Outcomes in Patients with Advanced Renal Dysfunction: Post-Hoc Analysis of the Kremezin Study against Renal Disease Progression in Korea","volume":"36","author":"Cha","year":"2017","journal-title":"Kidney Res. Clin. Pract."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1681\/ASN.2014010042","article-title":"Randomized Placebo-Controlled EPPIC Trials of AST-120 in CKD","volume":"26","author":"Schulman","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Schulman, G., Berl, T., Beck, G.J., Remuzzi, G., Ritz, E., Shimizu, M., Shobu, Y., and Kikuchi, M. (2016). The Effects of AST-120 on Chronic Kidney Disease Progression in the United States of America: A Post Hoc Subgroup Analysis of Randomized Controlled Trials. BMC Nephrol., 17.","DOI":"10.1186\/s12882-016-0357-9"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/2\/91\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:15:27Z","timestamp":1760159727000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/2\/91"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,26]]},"references-count":93,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["toxins13020091"],"URL":"https:\/\/doi.org\/10.3390\/toxins13020091","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,26]]}}}