Exploring metabolic dysfunction in chronic kidney disease

Slee, Adrian D. (2012) Exploring metabolic dysfunction in chronic kidney disease. Nutrition and Metabolism, 9 (1). pp. 36-51. ISSN 1743-7075

Full content URL: http://www.nutritionandmetabolism.com/content/9/1/...

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Abstract

Abstract
Impaired kidney function and chronic kidney disease (CKD) leading to kidney failure and end-stage renal disease
(ESRD) is a serious medical condition associated with increased morbidity, mortality, and in particular cardiovascular
disease (CVD) risk. CKD is associated with multiple physiological and metabolic disturbances, including hypertension,
dyslipidemia and the anorexia-cachexia syndrome which are linked to poor outcomes. Specific hormonal,
inflammatory, and nutritional-metabolic factors may play key roles in CKD development and pathogenesis. These
include raised proinflammatory cytokines, such as interleukin-1 and −6, tumor necrosis factor, altered hepatic acute
phase proteins, including reduced albumin, increased C-reactive protein, and perturbations in normal anabolic
hormone responses with reduced growth hormone-insulin-like growth factor-1 axis activity. Others include
hyperactivation of the renin-angiotensin aldosterone system (RAAS), with angiotensin II and aldosterone implicated
in hypertension and the promotion of insulin resistance, and subsequent pharmacological blockade shown to
improve blood pressure, metabolic control and offer reno-protective effects. Abnormal adipocytokine levels
including leptin and adiponectin may further promote the insulin resistant, and proinflammatory state in CKD.
Ghrelin may be also implicated and controversial studies suggest activities may be reduced in human CKD, and
may provide a rationale for administration of acyl-ghrelin. Poor vitamin D status has also been associated with
patient outcome and CVD risk and may indicate a role for supplementation. Glucocorticoid activities traditionally
known for their involvement in the pathogenesis of a number of disease states are increased and may be
implicated in CKD-associated hypertension, insulin resistance, diabetes risk and cachexia, both directly and indirectly
through effects on other systems including activation of the mineralcorticoid receptor. Insight into the multiple
factors altered in CKD may provide useful information on disease pathogenesis, clinical assessment and treatment
rationale such as potential pharmacological, nutritional and exercise therapies.

Keywords:Chronic kidney disease, Cachexia, Cardiovascular disease
Subjects:B Subjects allied to Medicine > B400 Nutrition
Divisions:College of Science > School of Life Sciences
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ID Code:7459
Deposited On:11 Feb 2013 16:15

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