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In addition to extracorporeal renal replacement strategies, which in chronic kidney disease (CKD) are largely reserved for the treatment of end-stage kidney failure, conservative measures can be taken to reduce concentration, effects, or both concentration and effects of uremic retention solutes. In this overview, we will focus on those therapies, which are aimed at preventing or delaying cardio-vascular disease, retarding or halting the progression of CKD, or both. We will discuss, consecutively, inhibitors of the renin-angiotensin-aldosterone axis, beta-blockers, calcium-channel antagonists, anti-inflammatory drugs, intestinal sorbents, calcimimetics, and glitazones. Some of these approaches could lead to a therapeutic breakthrough in the future. In addition, comprehensive tables will be provided for more traditional therapeutic approaches, such as lifestyle changes and other pharmaceutical treatments.

Acute kidney injury (AKI) is a serious and frequent condition which may fully resolve but is associated with markedly increased mortality. Mortality in AKI is caused by nonrenal, distant organ failure. Renal recovery from AKI is often not achieved on account of new injuries in the repair phase. Uremic toxins may be the missing link between AKI and nonrenal organ failure, tubular and endothelial injury. Compared with chronic kidney disease (CKD), research of uremic toxins in AKI is in its infancy. This review presents the current knowledge on uremic toxins in AKI which is predominately derived from experimental studies. Most uremic toxins investigated have previously been identified in CKD. The review focuses on those uremic toxins with biologic effect on the respective nonrenal organs failing in AKI and on the renal tubule and the endothelium. These uremic toxins may insofar be specific mediators of pathophysiological processes in AKI.

In this publication, we review the activities of the European Uremic Toxin Work Group (EUTox) in the field of uremic toxin research. Founded in 1999 under the umbrella of the European Society of Artificial Organs (ESAO), and active since 2000, this group focuses essentially on questions related to solute retention and removal during chronic kidney disease, and on the deleterious impact of those solutes on biological/biochemical systems. As of January 1, 2009, the group had met 28 times; it organized the third meeting, "Uremic Toxins in Cardiovascular Disease," which took place in October 2008 in Amiens, France. The current group is composed of 25 members belonging to 23 European research institutions. As of November 1, 2008, in total 69 papers had been published to which at least two different research groups belonging to EUTox have contributed in a collaborative effort. Of these, 40 papers were on original research and eight were specific EUTox reviews or position statements. A website (http://www.eutox.info) summarizes all relevant information concerning the work group. EUTox also developed an interactive uremic toxin database, where concentrations of known toxins are displayed, to be used by researchers in the field. In the future, EUTox intends to continue its focus on bench to bedside research with specific consideration of proteomics, metabonomics, secretomics, and genomics. © 2009 Wiley Periodicals, Inc.