Abstract
Uremic toxins (UTs) are mainly produced by protein metabolized by the intestinal microbiota and converted in the liver or by mitochondria or other enzymes. The accumulation of UTs can damage the intestinal barrier integrity and cause vascular damage and progressive kidney damage. Together, these factors lead to metabolic imbalances, which in turn increase oxidative stress and inflammation and then produce uremia that affects many organs and causes diseases including renal fibrosis, vascular disease, and renal osteodystrophy. This article is based on the theory of the intestinal–renal axis, from bench to bedside, and it discusses nonextracorporeal therapies for UTs, which are classified into three categories: medication, diet and supplement therapy, and complementary and alternative medicine (CAM) and other therapies. The effects of medications such as AST-120 and meclofenamate are described. Diet and supplement therapies include plant-based diet, very low-protein diet, probiotics, prebiotics, synbiotics, and nutraceuticals. The research status of Chinese herbal medicine is discussed for CAM and other therapies. This review can provide some treatment recommendations for the reduction of UTs in patients with chronic kidney disease.
Highlights
Chronic kidney disease (CKD) is characterized by a gradual decrease in the glomerular filtration rate and proteinuria
Supplementation and intravenous (i.v.) injection of Me-Cbl plus oral Folic acid (FA) normalized plasma total Hcy; i.v. injection of Me-Cbl showed no change [34]. Another randomized controlled trials (RCTs) reported that patients undergoing HD who received i.v. injection of Me-Cbl plus oral FA showed a reduction in Hcy and asymmetric dimethylarginine (ADMA) levels; this reduction possibly resulted from an increase in the metabolic degradation of uremic toxins (UTs) [25]
Uremic clearance granule (UCG), called as NiaoDuQing (NDQ), created based on the traditional Chinese medicine (TCM) theory consisting of 16 herbs, such as Rheum officinale, Glycyrrhiza uralensis, Astragalus membranaceus, Poria cocos, Sophora flavescens, Chrysanthemum morifolium, and so forth, is the first Chinese medicine approved by the China Food and Drug Administration for the treatment of CKD
Summary
Chronic kidney disease (CKD) is characterized by a gradual decrease in the glomerular filtration rate and proteinuria. The pathophysiological mechanisms through which UTs cause multiple organ damage are complex and not completely understood These mechanisms may include inflammation, reactive oxidative stress, cellular transdifferentiation, impaired mitochondria function, intestinal barrier destruction, and changes in intestinal microbiota [12,13,14]. CKD can lead to the appearance of compounds that destroy mitochondria, and subsequent mitochondrial damage can cause further accumulation of UTs; the synthesis of UTs is related to mitochondria [14]. UTs can accelerate the deterioration of kidney function, leading to a vicious circle All these factors together lead to the typical destruction of normal metabolic balance and uremic homeostasis that results in inflammation and uremia, causing multiple organ damage [12]. The final section describes complementary and alternative medicine (CAM) and other therapies
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