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Ren X, Chen J, Abraham AG, Xu Y, Siewe A, Warady BA, Kimmel PL, Vasan RS, Rhee EP, Furth SL, Coresh J, Denburg M, Rebholz CM. Plasma Metabolomics of Dietary Intake of Protein-Rich Foods and Kidney Disease Progression in Children. J Ren Nutr 2024; 34:95-104. [PMID: 37944769 PMCID: PMC10960708 DOI: 10.1053/j.jrn.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/12/2023] [Accepted: 10/21/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Evidence regarding the efficacy of a low-protein diet for patients with CKD is inconsistent and recommending a low-protein diet for pediatric patients is controversial. There is also a lack of objective biomarkers of dietary intake. The purpose of this study was to identify plasma metabolites associated with dietary intake of protein and to assess whether protein-related metabolites are associated with CKD progression. METHODS Nontargeted metabolomics was conducted in plasma samples from 484 Chronic Kidney Disease in Children (CKiD) participants. Multivariable linear regression estimated the cross-sectional association between 949 known, nondrug metabolites and dietary intake of total protein, animal protein, plant protein, chicken, dairy, nuts and beans, red and processed meat, fish, and eggs, adjusting for demographic, clinical, and dietary covariates. Cox proportional hazards models assessed the prospective association between protein-related metabolites and CKD progression defined as the initiation of kidney replacement therapy or 50% eGFR reduction, adjusting for demographic and clinical covariates. RESULTS One hundred and twenty-seven (26%) children experienced CKD progression during 5 years of follow-up. Sixty metabolites were significantly associated with dietary protein intake. Among the 60 metabolites, 10 metabolites were significantly associated with CKD progression (animal protein: n = 1, dairy: n = 7, red and processed meat: n = 2, nuts and beans: n = 1), including one amino acid, one cofactor and vitamin, 4 lipids, 2 nucleotides, one peptide, and one xenobiotic. 1-(1-enyl-palmitoyl)-2-oleoyl-glycerophosphoethanolamine (GPE, P-16:0/18:1) was positively associated with dietary intake of red and processed meat, and a doubling of its abundance was associated with 88% higher risk of CKD progression. 3-ureidopropionate was inversely associated with dietary intake of red and processed meat, and a doubling of its abundance was associated with 48% lower risk of CKD progression. CONCLUSIONS Untargeted plasma metabolomic profiling revealed metabolites associated with dietary intake of protein and CKD progression in a pediatric population.
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Affiliation(s)
- Xuyuehe Ren
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Yunwen Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Aisha Siewe
- Division of Cardiology, Department of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bradley A Warady
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes, Digestive, and Kidney Disorders, National Institutes of Health, Bethesda, Maryland; Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, Washington, District of Columbia
| | | | - Eugene P Rhee
- Nephrology Division and Endocrinology Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan L Furth
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle Denburg
- Division of Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Casey M Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Tang CF, Wu MY, Wei YH, Ho Y, Kuo KL. Leukocyte 8-hydroxy-2'-deoxyguanosine as an oxidative stress marker to predict cardiovascular events and death in chronic hemodialysis patients. J Chin Med Assoc 2023; 86:911-916. [PMID: 37563751 DOI: 10.1097/jcma.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Hemodialysis patients have a markedly increased risk of cardiovascular (CV) morbidity and mortality. Oxidative stress plays a pathogenic role in the progression of atherosclerosis and CV disease among chronic hemodialysis patients. The 8-hydroxy-2'-deoxyguanosine (8-OHdG) content in leukocyte deoxyribonucleic acid (DNA) has been shown as a sensitive and well-known biomarker of oxidant-induced DNA damage in chronic hemodialysis patients. METHODS We conducted a retrospective cohort study to investigate the association of leukocyte 8-OHdG and CV events and deaths in patients of chronic hemodialysis. In this study, 217 chronic hemodialysis patients were recruited from 2016 to 2021. The 8-OHdG content of leukocyte DNA was measured by a high-performance liquid chromatography electrochemical detection method. Study outcomes were CV events as well as CV and all-cause deaths. The patients were followed until May 2021. RESULTS The median follow-up period was 34.8 months. At the end of May 2021, 57 first CV events and 89 all-CV events occurred. Among the first and all CV events, 17 (29.8%) and 32 (36.0%) were fatal, respectively. Multivariate Cox regression analysis showed per 1/10 5 dG increment in leukocyte 8-OHdG values increased risk of CV events (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.10-1.41; p < 0.001), CV death (aHR, 1.27; 95% CI, 1.03-1.72; p = 0.034), and all-cause death (aHR, 1.11; 95% CI, 1.01-1.30; p = 0.038). CONCLUSION This is the first study to demonstrate that oxidative stress assessed by 8-OHdG levels of leukocyte DNA predicted CV events as well as CV and all-cause deaths among chronic hemodialysis patients.
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Affiliation(s)
- Ching-Fang Tang
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Mei-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Medical University Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan, ROC
- College of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Yau-Huei Wei
- Center for Mitochondrial Medicine and Free Radical Research, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Yang Ho
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan, ROC
- School of Medicine, Tzu Chi University, Hualien, Taiwan, ROC
- School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan, ROC
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3
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Zhang YQ, Jiang YF, Chen M, Zhang NN, Zhou YF. Association between myeloperoxidase rs2333227 polymorphism and susceptibility to coronary heart disease. Arch Med Sci 2020; 16:1231-1238. [PMID: 32864014 PMCID: PMC7444730 DOI: 10.5114/aoms.2020.95462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/15/2018] [Indexed: 01/11/2023] Open
Affiliation(s)
- Yi-Qing Zhang
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Yu-Feng Jiang
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Min Chen
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Nan-Nan Zhang
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
| | - Ya-Feng Zhou
- Department of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China
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Qin J, Xing J, Li W, Zhang K, Wu Z. Association between MPO-463G > A polymorphism and chronic kidney disease: a meta-analysis. Ren Fail 2018; 40:541-546. [PMID: 30278820 PMCID: PMC6171445 DOI: 10.1080/0886022x.2018.1499529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Previous studies have shown that MPO -463G > A (rs2333227) might be associated with chronic kidney disease (CKD) susceptibility, but sample sizes of those studies are relatively small. Hence, we decided to perform a meta-analysis to evaluate the association. Methods/main results: Two investigators search databases systematically and independently. Odds ratios and 95% confidence intervals were used to pool the effect size. Four articles with 618 cases and 932 controls in total were included in our meta-analysis. CONCLUSIONS MPO -463G > A was not associated with CKD susceptibility in recessive model and homozygote comparison. MPO -463G > A was associated with increased risk of CKD in allelic comparison, heterozygote comparison and dominant model, however, the results lacked stability. Owing to insufficient data, the association between MPO -463G > A and CKD cannot be fully confirmed.
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Affiliation(s)
- Jiaxuan Qin
- a Department of Urology Surgery , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.,b Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University Xiamen , Fujian , China.,c The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China
| | - Jinchun Xing
- a Department of Urology Surgery , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.,b Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University Xiamen , Fujian , China.,c The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China
| | - Wei Li
- a Department of Urology Surgery , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.,b Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University Xiamen , Fujian , China.,c The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China
| | - Kaiyan Zhang
- a Department of Urology Surgery , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.,b Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University Xiamen , Fujian , China.,c The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China
| | - Zhun Wu
- a Department of Urology Surgery , The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China.,b Center of Diagnosis and Treatment of Urinary System Diseases, The First Affiliated Hospital of Xiamen University Xiamen , Fujian , China.,c The Key Laboratory of Urinary Tract Tumors and Calculi of Xiamen City, The First Affiliated Hospital of Xiamen University , Xiamen , Fujian , China
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5
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Zeng L, Mathew AV, Byun J, Atkins KB, Brosius FC, Pennathur S. Myeloperoxidase-derived oxidants damage artery wall proteins in an animal model of chronic kidney disease-accelerated atherosclerosis. J Biol Chem 2018; 293:7238-7249. [PMID: 29581235 DOI: 10.1074/jbc.ra117.000559] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
Increased myeloperoxidase (MPO) levels and activity are associated with increased cardiovascular risk among individuals with chronic kidney disease (CKD). However, a lack of good animal models for examining the presence and catalytic activity of MPO in vascular lesions has impeded mechanistic studies into CKD-associated cardiovascular diseases. Here, we show for the first time that exaggerated atherosclerosis in a pathophysiologically relevant CKD mouse model is associated with increased macrophage-derived MPO activity. Male 7-week-old LDL receptor-deficient mice underwent sham (control mice) or 5/6 nephrectomy and were fed either a low-fat or high-fat, high-cholesterol diet for 24 weeks, and the extents of atherosclerosis and vascular reactivity were assessed. MPO expression and oxidation products-protein-bound oxidized tyrosine moieties 3-chlorotyrosine, 3-nitrotyrosine, and o,o'-dityrosine-were examined with immunoassays and confirmed with mass spectrometry (MS). As anticipated, the CKD mice had significantly higher plasma creatinine, urea nitrogen, and intact parathyroid hormone along with lower hematocrit and body weight. On both the diet regimens, CKD mice did not have hypertension but had lower cholesterol and triglyceride levels than the control mice. Despite the lower cholesterol levels, CKD mice had increased aortic plaque areas, fibrosis, and luminal narrowing. They also exhibited increased MPO expression and activity (i.e. increased oxidized tyrosines) that co-localized with infiltrating lesional macrophages and diminished vascular reactivity. In summary, unlike non-CKD mouse models of atherosclerosis, CKD mice exhibit increased MPO expression and catalytic activity in atherosclerotic lesions, which co-localize with lesional macrophages. These results implicate macrophage-derived MPO in CKD-accelerated atherosclerosis.
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Affiliation(s)
- Lixia Zeng
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105
| | - Anna V Mathew
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105
| | - Jaeman Byun
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105
| | - Kevin B Atkins
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105
| | - Frank C Brosius
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48105
| | - Subramaniam Pennathur
- Department of Medicine, Division of Nephrology, Ann Arbor, Michigan 48105; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48105.
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Duni A, Liakopoulos V, Rapsomanikis KP, Dounousi E. Chronic Kidney Disease and Disproportionally Increased Cardiovascular Damage: Does Oxidative Stress Explain the Burden? OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:9036450. [PMID: 29333213 PMCID: PMC5733207 DOI: 10.1155/2017/9036450] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023]
Abstract
Chronic kidney disease (CKD) patients are among the groups at the highest risk for cardiovascular disease and significantly shortened remaining lifespan. CKD enhances oxidative stress in the organism with ensuing cardiovascular damage. Oxidative stress in uremia is the consequence of higher reactive oxygen species (ROS) production, whereas attenuated clearance of pro-oxidant substances and impaired antioxidant defenses play a complementary role. The pathophysiological mechanism underlying the increased ROS production in CKD is at least partly mediated by upregulation of the intrarenal angiotensin system. Enhanced oxidative stress in the setting of the uremic milieu promotes enzymatic modification of circulating lipids and lipoproteins, protein carbamylation, endothelial dysfunction via disruption of nitric oxide (NO) pathways, and activation of inflammation, thus accelerating atherosclerosis. Left ventricular hypertrophy (LVH) and heart failure are hallmarks of CKD. NADPH oxidase activation, xanthine oxidase, mitochondrial dysfunction, and NO-ROS are the main oxidative pathways leading to LVH and the cardiorenal syndrome. Finally, a subset of antioxidant enzymes, the paraoxonases (PON), deserves special attention due to abundant clinical evidence accumulated regarding reduced serum PON1 activity in CKD as a contributor to the increased burden of cardiovascular disease. Future, meticulously designed studies are needed to assess the effects of antioxidant therapy on patients with CKD.
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Affiliation(s)
- Anila Duni
- Department of Nephrology, Medical School of the University of Ioannina, Ioannina, Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Evangelia Dounousi
- Department of Nephrology, Medical School of the University of Ioannina, Ioannina, Greece
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7
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Xu H, Watanabe M, Qureshi AR, Heimbürger O, Bárány P, Anderstam B, Eriksson M, Stenvinkel P, Lindholm B. Oxidative DNA damage and mortality in hemodialysis and peritoneal dialysis patients. Perit Dial Int 2015; 35:206-15. [PMID: 24584621 PMCID: PMC4406316 DOI: 10.3747/pdi.2013.00259] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/02/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Increased oxidative stress in dialysis patients is thought to contribute to increased mortality; however, confirmatory data are scarce. We analyzed the serum concentration of 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of oxidative stress, in relation to mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS Serum 8-OHdG, interleukin 6 (IL-6), other biochemical markers, Davies comorbidity score, and protein-energy wasting (PEW) were assessed in 303 prevalent patients treated with HD (n = 220; age: 63 ± 14 years) or PD (n = 83; age: 64 ± 14 years). Mortality was assessed after a median follow-up of 31 months. RESULTS The median (25th - 75th percentile) concentration of 8-OHdG was higher in HD than in PD patients: 1.3 ng/mL (0.9 - 1.8 ng/mL) versus 0.5 ng/mL (0.4 - 0.6 ng/mL), p < 0.001. The HD modality (standard β = 0.57, p < 0.001) and dialysis vintage (standard β = 0.12, p = 0.02) were independent predictors of serum 8-OHdG in a multivariable linear regression model including age, sex, body mass index, dialysis modality (HD or PD), preceding time on dialysis (dialysis vintage), PEW, comorbidity score, IL-6, and use of angiotensin converting-enzyme inhibitors or angiotensin II receptor blockers or statins. During follow-up, 107 patients died. In multivariable Cox regression models including all 303 patients and adjusted for age, sex, body mass index, dialysis modality, dialysis vintage, and comorbidity score, 8-OHdG was significantly associated with all-cause mortality (adjusted hazard ratio: 1.40; 95% confidence limits: 1.05, 1.87 for 1 standard deviation increase of 8-OHdG). In subgroup analyses according to dialysis modality, 8-OHdG was associated with mortality in HD patients but not in PD patients. CONCLUSIONS Oxidative stress as assessed by 8-OHdG is an independent predictor of all-cause mortality in dialysis patients. This association was seen in HD patients, but no such association could be demonstrated for PD patients.
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Affiliation(s)
- Hong Xu
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, PR China
| | - Makoto Watanabe
- Division of Nephrology, Department of Medicine, Showa University School of Medicine Tokyo, Tokyo, Japan
| | - Abdul Rashid Qureshi
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Olof Heimbürger
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Peter Bárány
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Björn Anderstam
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Monica Eriksson
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Bossola M, Tazza L. Wishful Thinking: The Surprisingly Sparse Evidence for a Relationship between Oxidative Stress and Cardiovascular Disease in Hemodialysis Patients. Semin Dial 2015; 28:224-30. [PMID: 25641650 DOI: 10.1111/sdi.12345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The increased frequency of cardiovascular disease observed in hemodialysis patients is secondary to the combination of many traditional (age, male sex, hypertension, smoking, diabetes mellitus, and dyslipidemia) and novel and uremia-related (inflammation, uremic toxins, adipokine imbalance, coagulation disorders, protein-energy wasting, volume overload, endothelial dysfunction, hyperparathyroidism, and subclinical hypothyroidism) risk factors. Usually, in the latter group, oxidative stress is included. However, after decades of research, it remains essentially unknown if oxidative stress has a causative role in the development of cardiovascular disease in long-term hemodialysis patients because adequate longitudinal studies are lacking. Data deriving from cross-sectional studies suggest that biomarkers of oxidative stress are associated with cardiovascular disease prevalence. Conversely, conflicting and inconclusive results have been obtained on the association between oxidative stress and coronary artery calcification, atherosclerosis, and all-cause and cardiovascular disease-related outcome. It is desirable that further studies are conducted on this topic in the near future.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Unit, Division of Transplantation, Catholic University of the Sacred Heart, "Agostino Gemelli" University Hospital, Rome, Italy
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Gosmanova EO, Le NA. Cardiovascular Complications in CKD Patients: Role of Oxidative Stress. Cardiol Res Pract 2011; 2011:156326. [PMID: 21253517 PMCID: PMC3022166 DOI: 10.4061/2011/156326] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/08/2010] [Indexed: 11/20/2022] Open
Abstract
Starting with the early stages, patients with chronic kidney disease (CKD) experience higher burden of cardiovascular disease (CVD). Moreover, CVD complications are the major cause of mortality in CKD patients as compared with complications from chronic kidney failure. While traditional CVD risk factors, including diabetes, hypertension, hyperlipidemia, obesity, physical inactivity, may be more prevalent among CKD patients, these factors seem to underestimate the accelerated cardiovascular disease in the CKD population. Search for additional biomarkers that could explain the enhanced CVD risk in CKD patients has gained increasing importance. Although it is unlikely that any single nontraditional risk factor would fully account for the increased CVD risk in individuals with CKD, oxidative stress appears to play a central role in the development and progression of CVD and its complications. We will review the data that support the contribution of oxidative stress in the pathogenesis of CVD in patients with chronic kidney failure.
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Affiliation(s)
- Elvira O Gosmanova
- Nephrology Division, Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38103, USA
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10
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Abstract
Patients with chronic kidney disease (CKD) are at increased risk of atherosclerotic cardiovascular disease and loss of renal parenchyma accelerates atherosclerosis in animal models. Macrophages are central to atherogenesis because they regulate cholesterol traffic and inflammation in the arterial wall. CKD influences macrophage behavior at multiple levels, rendering them proatherogenic. Even at normal creatinine levels, macrophages from uninephrectomized Apoe(-/-) mice are enriched in cholesterol owing to downregulation of cholesterol transporter ATP-binding cassette subfamily A member 1 levels and activation of nuclear factor κB, which leads to impaired cholesterol efflux. Interestingly, treatment with an angiotensin-II-receptor blocker (ARB) improves these effects. Moreover, atherosclerotic aortas from Apoe(-/-) mice transplanted into renal-ablated normocholesterolemic recipients show plaque progression and increased macrophage content instead of the substantial regression seen in recipient mice with intact kidneys. ARBs reduce atherosclerosis development in mice with partial renal ablation. These results, combined with the clinical benefits of angiotensin-converting-enzyme (ACE) inhibitors and ARBs in patients with CKD, suggest an important role for the angiotensin system in the enhanced susceptibility to atherosclerosis seen across the spectrum of CKD. The role of macrophages could explain why these therapies may be effective in end-stage renal disease, one of the few conditions in which statins show no clinical benefit.
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Affiliation(s)
- Valentina Kon
- Department of Pediatrics, Vanderbilt University Medical Center, 383 Preston Research Building, 2220 Pierce Avenue, Nashville, TN 37332-6300, USA
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11
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Bedard K, Attar H, Bonnefont JÃ, Jaquet V, Borel C, Plastre O, Stasia MJ, Antonarakis SE, Krause KH. Three common polymorphisms in theCYBAgene form a haplotype associated with decreased ROS generation. Hum Mutat 2009; 30:1123-33. [DOI: 10.1002/humu.21029] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Oxidative stress and inflammation, a link between chronic kidney disease and cardiovascular disease. Kidney Int 2009:S4-9. [PMID: 19034325 DOI: 10.1038/ki.2008.516] [Citation(s) in RCA: 430] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patients with chronic kidney disease (CKD) show a high cardiovascular morbidity and mortality. This seems to be consequence of the cardiovascular risk factor clustering in CKD patients. Non traditional risk factors such as oxidative stress and inflammation are also far more prevalent in this population than in normal subjects. Renal disease is associated with a graded increase in oxidative stress markers even in early CKD. This could be consequence of an increase in reactive oxygen species as well as a decrease in antioxidant defence. This oxidative stress can accelerate renal injury progression. Inflammatory markers such as C reactive protein and cytokines increase with renal function deterioration suggesting that CKD is a low-grade inflammatory process. In fact, inflammation facilitates renal function deterioration. Several factors can be involved in triggering the inflammatory process including oxidative stress. Statin administration is accompanied by risk reduction in all major vascular events in patients with CKD that are considered high-risk patients. These beneficial effects seem to be consequence of not only their hypolipidemic effect but especially their pleitropic actions that involve modulation of oxidative stress and inflammation.
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Davies MJ, Hawkins CL, Pattison DI, Rees MD. Mammalian heme peroxidases: from molecular mechanisms to health implications. Antioxid Redox Signal 2008; 10:1199-234. [PMID: 18331199 DOI: 10.1089/ars.2007.1927] [Citation(s) in RCA: 423] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A marked increase in interest has occurred over the last few years in the role that mammalian heme peroxidase enzymes, primarily myeloperoxidase, eosinophil peroxidase, and lactoperoxidase, may play in both disease prevention and human pathologies. This increased interest has been sparked by developments in our understanding of polymorphisms that control the levels of these enzymes, a greater understanding of the basic chemistry and biochemistry of the oxidants formed by these species, the development of specific biomarkers that can be used in vivo to detect damage induced by these oxidants, the detection of active forms of these peroxidases at most, if not all, sites of inflammation, and a correlation between the levels of these enzymes and a number of major human pathologies. This article reviews recent developments in our understanding of the enzymology, chemistry, biochemistry and biologic roles of mammalian peroxidases and the oxidants that they generate, the potential role of these oxidants in human disease, and the use of the levels of these enzymes in disease prognosis.
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Affiliation(s)
- Michael J Davies
- The Heart Research Institute, Camperdown, University of Sydney, Sydney, Australia., Faculty of Medicine, University of Sydney, Sydney, Australia.
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Dolley G, Lamarche B, Després JP, Bouchard C, Pérusse L, Vohl MC. Myeloperoxidase gene sequence variations are associated with low-density-lipoprotein characteristics. J Hum Genet 2008; 53:439-446. [DOI: 10.1007/s10038-008-0267-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 02/01/2008] [Indexed: 11/27/2022]
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Pecoits–Filho R. Applying Translational Research in Understanding Complications and Defining Targets for Intervention: Inflammation in PD as a Model. ARCH ESP UROL 2008. [DOI: 10.1177/089686080902900204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The bench-to-bedside approach to translational research is becoming increasingly important to efficiently advance understanding of the mechanisms underlying disease and to improve the quality of patient care. Although this investigation model has been practiced since the early days of the therapy, robust research platforms built to practice translational research have only recently been structured in the field of peritoneal dialysis. Experience with a translational research environment that generated most of the information cited in this overview is the core of this manuscript. The central investigation theme described is how to approach the cardiovascular complications of peritoneal dialysis. The research question was, could the continuous activation of inflammatory pathways be central in this process and represent a relevant target for interventions?
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Affiliation(s)
- Roberto Pecoits–Filho
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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