Uremic toxins. Back to the future

In the review, the author returns to the topic of uremia and uremic toxins, their importance for practitioners in the treatment using renal replacement therapies, gives a modern look at their classification, place during the onset and development of pathological processes in the progression of chronic kidney disease. However, current guidelines and studies for the treatment of chro­nic kidney disease indicate a lack of attention to the role and importance of uremic toxins in the predialysis stages of uremia treatment, in particular to the possible damaging effects of substances retained in the body with reduced glomerular filtration, directly to the renal function. The tables with the list of uremic toxins according to their classification are presented. References are made to the results of clinical and laboratory studies of uremic toxins, their impact on the general clinical picture of uremia and ways of their influence on the progression of chronic kidney disease and the further progression of the clinical picture of uremia. Attention is drawn to the fact that substances recognized as uremic toxins are present in healthy individuals without manifestations of their negative effects, and therefore the opinion is expressed about the need to study the physiological significance of these solvents under normal glomerular filtration. The question arises about the consideration of the factors of uremic toxins impact as a point of application in terms of the progression of chronic kidney disease and the use of this knowledge in renoprotective therapy in the predialysis stages of chronic kidney disease.