Do middle molecules cause uremic intoxication? (Con).

Middle molecules in a weight range of 500-50-00 daltons exists in uremic patients and patients on dialysis. These middle molecules have in vitro toxicity that has been most convincingly demonstrated to be directed against the immune system. Whether the levels can be influenced by varying their removal rates during dialysis, remains unknown. There are no convincing studies, either short- or long-term that has associated their levels in dialyzed patients with specific toxic symptoms. Both long- and short-term studies of their concentration levels and associating these with acute ill effects of dialysis and long-term damage to the immune system, possibly resulting in infections or cancers are necessary.