Ischemic preconditioning protects the heart against ischemia-reperfusion injury in chronic kidney disease in both males and females

Background Uremic cardiomyopathy is a common cardiovascular complication of chronic kidney disease (CKD) characterized by left ventricular hypertrophy (LVH) and fibrosis enhancing the susceptibility of the heart to acute myocardial infarction. In the early stages of CKD, approximately 60% of patients are women. We aimed to investigate the influence of sex on the severity of uremic cardiomyopathy and the infarct size-limiting effect of ischemic preconditioning (IPRE) in experimental CKD. Methods CKD was induced by 5/6 nephrectomy in 9-week-old male and female Wistar rats. Two months later, serum and urine laboratory parameters were measured to verify the development of CKD. Transthoracic echocardiography was performed to assess cardiac function and morphology. Cardiomyocyte hypertrophy and fibrosis were measured by histology. Left ventricular expression of A- and B-type natriuretic peptides (ANP and BNP) were measured by qRT-PCR and circulating BNP level was measured by ELISA. In a subgroup of animals, hearts were perfused according to Langendorff and were subjected to 35 min global ischemia and 120 min reperfusion with or without IPRE (3 × 5 min I/R cycles applied before index ischemia). Then infarct size or phosphorylated and total forms of proteins related to the cardioprotective RISK (AKT, ERK1,2) and SAFE (STAT3) pathways were measured by Western blot. Results The severity of CKD was similar in males and females. However, CKD males developed more severe LVH compared to females as assessed by echocardiography. Histology revealed cardiac fibrosis only in males in CKD. LV ANP expression was significantly increased due to CKD in both sexes, however, LV BNP and circulating BNP levels failed to significantly increase in CKD. In both sexes, IPRE significantly decreased the infarct size in both the sham-operated and CKD groups. IPRE significantly increased the phospho-STAT3/STAT3 ratio in sham-operated but not in CKD animals in both sexes. There were no significant differences in phospho-AKT/AKT and phospho-ERK1,2/ERK1,2 ratios between the groups. Conclusion The infarct size-limiting effect of IPRE was preserved in both sexes in CKD despite the more severe uremic cardiomyopathy in male CKD rats. Further research is needed to identify crucial molecular mechanisms in the cardioprotective effect of IPRE in CKD. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00392-1.
Highlights There was no difference in the severity of chronic kidney disease (CKD) between male and female rats based on serum urea and creatinine levels as well as creatinine clearance.As compared to females, males developed a more severe uremic cardiomyopathy characterized by left ventricular hypertrophy and fibrosis in CKD based on echocardiography and histology.Following ischemia/reperfusion, infarct size was significantly smaller in females than in males, both in the sham-operated and CKD groups.The infarct size-limiting effect of ischemic preconditioning (IPRE) was preserved in both sexes in CKD despite the more severe uremic cardiomyopathy in male CKD rats.IPRE significantly increased the phospho-STAT3/STAT3 ratio in sham-operated, but not in CKD animals in both sexes. Supplementary Information The online version contains supplementary material available at 10.1186/s13293-021-00392-1.