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Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins.
- Source :
-
Toxins [Toxins (Basel)] 2020 Dec 21; Vol. 12 (12). Date of Electronic Publication: 2020 Dec 21. - Publication Year :
- 2020
-
Abstract
- Uremic vascular calcification (VC) commonly occurs during advanced chronic kidney disease (CKD) and significantly increases cardiovascular morbidity and mortality. Uremic toxins are integral within VC pathogenesis, as they exhibit adverse vascular influences ranging from atherosclerosis, vascular inflammation, to VC. Experimental removal of these toxins, including small molecular (phosphate, trimethylamine-N-oxide), large molecular (fibroblast growth factor-23, cytokines), and protein-bound ones (indoxyl sulfate, p -cresyl sulfate), ameliorates VC. As most uremic toxins share a gut origin, interventions through gastrointestinal tract are expected to demonstrate particular efficacy. The "gastrointestinal decontamination" through the removal of toxin in situ or impediment of toxin absorption within the gastrointestinal tract is a practical and potential strategy to reduce uremic toxins. First and foremost, the modulation of gut microbiota through optimizing dietary composition, the use of prebiotics or probiotics, can be implemented. Other promising strategies such as reducing calcium load, minimizing intestinal phosphate absorption through the optimization of phosphate binders and the inhibition of gut luminal phosphate transporters, the administration of magnesium, and the use of oral toxin adsorbent for protein-bound uremic toxins may potentially counteract uremic VC. Novel agents such as tenapanor have been actively tested in clinical trials for their potential vascular benefits. Further advanced studies are still warranted to validate the beneficial effects of gastrointestinal decontamination in the retardation and treatment of uremic VC.
- Subjects :
- Clinical Trials as Topic methods
Gastrointestinal Microbiome drug effects
Gastrointestinal Microbiome physiology
Gastrointestinal Tract drug effects
Gastrointestinal Tract physiopathology
Humans
Indican pharmacology
Indican therapeutic use
Isoquinolines pharmacology
Isoquinolines therapeutic use
Renal Insufficiency, Chronic drug therapy
Renal Insufficiency, Chronic physiopathology
Sulfonamides pharmacology
Sulfonamides therapeutic use
Uremia drug therapy
Uremia physiopathology
Vascular Calcification drug therapy
Vascular Calcification physiopathology
Decontamination methods
Gastrointestinal Tract metabolism
Renal Insufficiency, Chronic metabolism
Toxins, Biological toxicity
Uremia metabolism
Vascular Calcification metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 2072-6651
- Volume :
- 12
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Toxins
- Publication Type :
- Academic Journal
- Accession number :
- 33371477
- Full Text :
- https://doi.org/10.3390/toxins12120812