Up Front MattersApproaches to UremiaMeyer, Timothy W.*,†; Hostetter, Thomas H.‡ Author Information *Department of Medicine, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California; †Department of Medicine, Stanford University, Palo Alto, California; and ‡Department of Medicine, Case Western Reserve University, Cleveland, Ohio Correspondence: Dr. Timothy W. Meyer, Nephrology 111R, Palo Alto Veterans Affairs Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94303. Email: [email protected] Journal of the American Society of Nephrology 25(10):p 2151-2158, October 2014. | DOI: 10.1681/ASN.2013121264 Buy Metrics Abstract The development of dialysis was a dramatic step forward in medicine, allowing people who would soon have died because of lack of kidney function to remain alive for years. We have since found, however, that the “artificial kidney” does not live up fully to its name. Dialysis keeps patients alive but not well. Part of the residual illness that dialysis patients experience is caused by retained waste solutes that dialysis does not remove as well as native kidney function does. New means are available to identify these toxic solutes, about which we currently know remarkably little, and knowledge of these solutes would help us to improve therapy. This review summarizes our current knowledge of toxic solutes and highlights methods being explored to identify additional toxic solutes and to enhance the clearance of these solutes to improve patient outcomes. Copyright © 2014 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.