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.
Highlights
It is well known that the incidence of cardiovascular events and mortality is much higher in patients with chronic kidney disease (CKD) [1], because such patients, have classical risk factors for cardiovascular disease (CVD), such as hypertension, diabetes mellitus, dyslipidemia, and hyperuricemia, etc., and have many non-classical CKD-specific risk factors for CVD, including anemia, volume over-load, mineral bone disorders, inflammation, malnutrition, and activation of the sympathetic nervous system and renin-angiotensin-aldosterone systems, among others [2]
uremic toxins (UTs) are undoubtedly involved in the progression of multiple organ damage, the focus of the present review is on the roles of indoxyl sulfate (IS), asymmetric dimethylarginine (ADMA), and p‐cresylsulfate in the pathogenesis of the progression of CKD, CVD, and bone
It has been reported that atrial fibrillation (AF) is induced by atrial extrastimuli in hearts extracted from CKD model rats [70]
Summary
It is well known that the incidence of cardiovascular events and mortality is much higher in patients with chronic kidney disease (CKD) [1], because such patients, have classical risk factors for cardiovascular disease (CVD), such as hypertension, diabetes mellitus, dyslipidemia, and hyperuricemia, etc., and have many non-classical CKD-specific risk factors for CVD, including anemia, volume over-load, mineral bone disorders, inflammation, malnutrition, and activation of the sympathetic nervous system and renin-angiotensin-aldosterone systems, among others [2] One such non-classical CKD-specific risk factor is uremic toxins (UTs). UTs are undoubtedly involved in the progression of multiple organ damage, the focus of the present review is on the roles of indoxyl sulfate (IS), asymmetric dimethylarginine (ADMA), and p‐cresylsulfate (pCS) in the pathogenesis of the progression of CKD, CVD, and bone.
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