Role of Uremic Toxins for Kidney, Cardiovascular, and Bone Dysfunction
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Published on: November 7, 2017
Hideki Fujii1, Shunsuke Goto2, Masafumi Fukagawa3
1Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan. fhideki@med.kobe-u.ac.jp.
Insights
Uremic toxins (UTs) worsen kidney function, cardiovascular disease, and bone disorders in chronic kidney disease (CKD) patients. This review details the complex roles of specific UTs like indoxyl sulfate in these conditions.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Chronic kidney disease (CKD) is linked to cardiovascular disease (CVD) and mineral bone disorders.
- Non-traditional risk factors, including uremic toxins (UTs), contribute to these complications.
- Accumulation of UTs exacerbates kidney dysfunction.
Purpose of the Study:
- To review the pathophysiological effects of specific UTs on kidney, cardiovascular, and bone health.
- To discuss clinical data on the impact of UTs on CKD, CVD, and bone disease progression.
- To highlight indoxyl sulfate, asymmetric dimethylarginine, and p-cresylsulfate as key UTs of focus.
Main Methods:
- Literature review of experimental and clinical studies.
- Synthesis of data on the complex relationships between UTs and disease progression.
- Focus on the pathophysiological mechanisms and clinical evidence.
Main Results:
- UTs are complex, non-traditional risk factors in CKD progression.
- Specific UTs like indoxyl sulfate, asymmetric dimethylarginine, and p-cresylsulfate have significant pathophysiological influences.
- Clinical data support the detrimental effects of these UTs on kidney, cardiovascular, and bone health.
Conclusions:
- Uremic toxin accumulation is a critical factor in CKD, CVD, and bone disease.
- Further elucidation of UT pathophysiology is crucial for therapeutic strategies.
- Targeting specific UTs may offer new avenues for managing CKD complications.
Abstract:
With decreasing kidney function, cardiovascular disease (CVD) and mineral bone disorders frequently emerge in patients with chronic kidney disease (CKD). For these patients, in addition to the traditional risk factors, non-traditional CKD-specific risk factors are also associated with such diseases and conditions. One of these non-traditional risk factors is the accumulation of uremic toxins (UTs). In addition, the accumulation of UTs further deteriorates kidney function. Recently, a huge number of UTs have been identified. Although many experimental and clinical studies have reported associations between UTs and the progression of CKD, CVD, and bone disease, these relationships are very complex and have not been fully elucidated. Among the UTs, indoxyl sulfate, asymmetric dimethylarginine, and p-cresylsulfate have been of particular focus, up until now. In this review, we summarize the pathophysiological influences of these UTs on the kidney, cardiovascular system, and bone, and discuss the clinical data regarding the harmful effects of these UTs on diseases and conditions.
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