New Pathogenic Concepts and Therapeutic Approaches to Oxidative Stress in Chronic Kidney Disease

In chronic kidney disease inflammatory processes and stimulation of immune cells result in overproduction of free radicals. In combination with a reduced antioxidant capacity this causes oxidative stress. This review focuses on current pathogenic concepts of oxidative stress for the decline of kidney function and development of cardiovascular complications. We discuss the impact of mitochondrial alterations and dysfunction, a pathogenic role for hyperuricemia, and disturbances of vitamin D metabolism and signal transduction. Recent antioxidant therapy options including the use of vitamin D and pharmacologic therapies for hyperuricemia are discussed. Finally, we review some new therapy options in diabetic nephropathy including antidiabetic agents (noninsulin dependent), plant antioxidants, and food components as alternative antioxidant therapies.

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Oxidative Stress and Cardiovascular Complications in Chronic Kidney Disease, the Impact of Anaemia

Pharmaceuticals ◽

10.3390/ph11040103 ◽

2018 ◽

Vol 11 (4) ◽

pp. 103 ◽

Cited By ~ 11

Author(s):

Faisal Nuhu ◽

Sunil Bhandari

Keyword(s):

Oxidative Stress ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Short Review ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Cardiovascular Morbidity And Mortality ◽

Deleterious Consequence ◽

The Impact ◽

And Oxidative Stress

Patients with chronic kidney disease (CKD) have significant cardiovascular morbidity and mortality as a result of risk factors such as left ventricular hypertrophy (LVH), oxidative stress, and inflammation. The presence of anaemia in CKD further increases the risk of LVH and oxidative stress, thereby magnifying the deleterious consequence in uraemic cardiomyopathy (UCM), and aggravating progression to failure and increasing the risk of sudden cardiac death. This short review highlights the specific cardio-renal oxidative stress in CKD and provides an understanding of the pathophysiology and impact of uraemic toxins, inflammation, and anaemia on oxidative stress.

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FGF23, iron and vitamin D metabolism in chronic kidney disease

Endocrine Abstracts ◽

10.1530/endoabs.44.p61 ◽

2016 ◽

Author(s):

Isabelle Piec ◽

Allison Chipchase ◽

Holly Nicholls ◽

Jonathan Tang ◽

Christopher Washbourne ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Vitamin D Metabolism

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Vitamin D Metabolism and Potential Effects of Vitamin D Receptor Modulation in Chronic Kidney Disease

Current Drug Metabolism ◽

10.2174/1389200218666170427112735 ◽

2017 ◽

Vol 18 (7) ◽

Cited By ~ 3

Author(s):

Antonio Bellasi ◽

Andrea Galassi ◽

Michela Mangano ◽

Luca Di Lullo ◽

Mario Cozzolino

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Vitamin D Receptor ◽

Vitamin D Metabolism ◽

Receptor Modulation

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Fibroblast Growth Factor 23 and Disordered Vitamin D Metabolism in Chronic Kidney Disease: Updating the “Trade-off” Hypothesis: Figure 1.

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.02640310 ◽

2010 ◽

Vol 5 (9) ◽

pp. 1710-1716 ◽

Cited By ~ 91

Author(s):

Orlando M. Gutiérrez

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Growth Factor ◽

Kidney Disease ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 23 ◽

Fibroblast Growth ◽

Vitamin D Metabolism ◽

Trade Off

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Oxidative Balance and Inflammation in Hemodialysis Patients: Biomarkers of Cardiovascular Risk?

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/8567275 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 10

Author(s):

Daniele La Russa ◽

Daniela Pellegrino ◽

Alberto Montesanto ◽

Paolo Gigliotti ◽

Anna Perri ◽

...

Keyword(s):

Oxidative Stress ◽

Chronic Kidney Disease ◽

Renal Function ◽

Cardiovascular Risk ◽

Kidney Disease ◽

Cardiovascular Events ◽

Cardiovascular Complications ◽

Hemodialysis Patients ◽

Healthy Population ◽

Oxidative Balance

During chronic kidney disease, the progressive deterioration of renal function induces several biological/clinical dysfunctions, including enhancement of synthesis of inflammation/oxidative stress mediators. Impaired renal function is an independent cardiovascular risk factor; indeed, cardiovascular complications dominate the landscape of both chronic kidney disease and end-stage renal disease. The aim of this study is to explore the correlation between the global oxidative balance in hemodialysis patients and both inflammatory markers and cardiovascular events. Using photometric tests, this study explored plasmatic oxidative balance in 97 hemodialysis patients compared to a healthy population. In the hemodialysis patients, we showed that oxidative stress values were significantly lower than in controls while effectiveness in the antioxidant barrier was significantly increased in the hemodialysis group. Furthermore, we highlighted a strong correlation between oxidative index and blood levels of C-reactive protein. When patients were divided into two groups based on previous cardiovascular events, we found that subjects with previous cardiovascular events had higher values of both oxidative stress and antioxidant barrier than patients without cardiovascular events. Our results indicated that in hemodialysis patients, the clinical and prognostic significance of oxidative status is very different from general population. As cardiovascular complications represent a strong negative factor for survival of hemodialysis patients, the research of new cardiovascular risk biomarkers in these patients takes on particular importance in order to translate them into clinical practice/primary care.

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Vitamin D metabolism and activity as well as genetic variants of the vitamin D receptor (VDR) in chronic kidney disease patients

Journal of Nephrology ◽

10.5301/jn.5000203 ◽

2012 ◽

Vol 26 (4) ◽

pp. 636-644 ◽

Cited By ~ 20

Author(s):

Domenico Santoro ◽

Daniela Caccamo ◽

Giorgia Gagliostro ◽

Riccardo Ientile ◽

Salvatore Benvenga ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Kidney Disease ◽

Vitamin D Receptor ◽

Genetic Variants ◽

Vitamin D Metabolism

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Effect of Different Stages of Chronic Kidney Disease and Renal Replacement Therapies on Oxidant-Antioxidant Balance in Uremic Patients

Biochemistry Research International ◽

10.1155/2013/358985 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 31

Author(s):

Hadja Fatima Tbahriti ◽

Abbou Kaddous ◽

Malika Bouchenak ◽

Khedidja Mekki

Keyword(s):

Oxidative Stress ◽

Chronic Kidney Disease ◽

Antioxidant Enzymes ◽

Vitamin E ◽

Kidney Disease ◽

Thiobarbituric Acid ◽

Study Groups ◽

Cardiovascular Complications ◽

Protein Carbonyls ◽

Severe Stage

Oxidative stress seems to be involved in the path physiology of cardiovascular complications of chronic kidney disease (CKD). In this study, we determined the effect of different stages of CKD and substitutive therapies on oxidative stress. One hundred sixty-seven patients (age:44±06years; male/female: 76/91) with CKD were divided into 6 groups according to the National Kidney Foundation classification. Prooxidant status was assessed by assaying thiobarbituric acid reactive substances, hydroperoxides, and protein carbonyls. Antioxidant defence was performed by analysis of superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, vitamin E, Iron, and bilirubin. TBARS and LPO were higher in HD patients compared to other groups (P<0.001), while protein carbonyls were more increased in PD patients. The antioxidant enzymes were declined already at severe stage of CKD and they were declined notably in HD patients (P<0.001). Similar observation was found for vitamin E, Fe, and bilirubin where we observed a significant decrease in the majority of study groups, especially in HD patients (P<0.001). The evolution of CKD was associated with elevated OS. HD accentuates lipid, while PD aggravates protein oxidation. However, the activity of antioxidant enzymes was altered by impaired renal function and by both dialysis treatments.

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Pathophysiology of chronic kidney disease-mineral and bone disorder

10.1093/med/9780199592548.003.0117 ◽

2015 ◽

Author(s):

Alexandra Voinescu ◽

Nadia Wasi Iqbal ◽

Kevin J. Martin

Keyword(s):

Chronic Kidney Disease ◽

Vitamin D ◽

Parathyroid Hormone ◽

Kidney Disease ◽

Fibroblast Growth Factor 23 ◽

Serum Levels ◽

Mineral And Bone Disorder ◽

Vitamin D Metabolism ◽

Bone Disorder ◽

Calcium Phosphorus

Chronic kidney disease is associated with the inability to control normal mineral homeostasis, resulting in abnormalities in serum levels of calcium, phosphorus, parathyroid hormone, fibroblast growth factor 23 (FGF23) and vitamin D metabolism. These disturbances lead to the development of secondary hyperparathyroidism, skeletal abnormalities, vascular calcifications, and other systemic manifestations. Traditionally, mineral and bone abnormalities seen in chronic kidney disease were included in the term ‘renal osteodystrophy’. More recently, the term chronic kidney disease-mineral and bone disorder was introduced to define the biochemical abnormalities of phosphorus, parathyroid hormone, FGF23, calcium, or vitamin D metabolism, abnormalities in bone remodelling and mineralization, and vascular or other soft tissue calcifications.

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