Abstract
Chronic kidney disease (CKD) exhibits progressive kidney dysfunction and leads to disturbed homeostasis, including accumulation of uremic toxins, activated renin-angiotensin system, and increased oxidative stress and proinflammatory cytokines. Patients with CKD are prone to developing the peripheral vascular disease (PVD), leading to poorer outcomes than those without CKD. Cumulative evidence has showed that the synergy of uremic milieu and PVD could exaggerate vascular complications such as limb ischemia, amputation, stenosis, or thrombosis of a dialysis vascular access, and increase mortality risk. The role of uremic toxins in the pathogenesis of vascular dysfunction in CKD has been investigated. Moreover, growing evidence has shown the promising role of uremic toxins as a therapeutic target for PVD in CKD. This review focused on uremic toxins in the pathophysiology, in vitro and animal models, and current novel clinical approaches in reducing the uremic toxin to prevent peripheral vascular complications in CKD patients.
Highlights
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan
Serum phosphorus independently predicts the development of peripheral vascular disease (PVD)
PVD is more prevalent in Chronic kidney disease (CKD) than in the general population
Summary
Peripheral vascular disease (PVD), known as peripheral artery occlusive disease, is a common but devastating disease in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD), diabetes mellitus, hypertension, and dyslipidemia, especially in elderly patients. PVD could develop early and asymptomatically but progressively lead to limb ischemia, such as intermittent claudication, pain, ulceration, and gangrene. It is not an immediately life-threatening disease, PVD is associated with decreased functional capacity and quality of life but higher risks for mortality and cardiovascular morbidity [1,2]. By using the ankle–brachial index (ABI), more recent studies have shown that the prevalence of PVD is significantly higher in patients undergoing chronic dialysis or with CKD. The risk of developing incident PVD in patients with reduced kidney function was 56% higher than in non-CKD patients.
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