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This disruption leads to a dysregulation between pro-inflammatory and anti-inflammatory macrophages, coupled with mitochondrial damage, which ultimately results in chronic systemic uremic inflammation that is a hallmark of CKD ( Two protein-bound uremic toxins, indoxyl sulfate (IS) and p-cresyl sulfate (pCS), are resistant to removal via conventional dialysis

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It explains why your treatment history matters so much

Call a healthcare provider right away if you have any of these symptoms, especially if they are new, worse, or worry you: Thoughts about suicide or dying Attempts to commit suicide New or worse depression New or worse anxiety Panic attacks An extreme increase in activity and talking (mania) Feeling agitated or restless Trouble sleeping (insomnia) New or worse irritability Acting aggressive, being angry or violent Acting on dangerous impulses Other unusual changes in behavior or mood Topiramate may lower bone mineral density