Next Article in Journal
Engineering Botulinum Neurotoxins for Enhanced Therapeutic Applications and Vaccine Development
Next Article in Special Issue
Role of Uremic Toxins in Early Vascular Ageing and Calcification
Previous Article in Journal / Special Issue
Effects of Chronic Kidney Disease and Uremic Toxins on Extracellular Vesicle Biology
Review

Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins

by 1,2,3 and 4,*
1
Nephrology Division, Department of Medicine, National Taiwan University Hospital BeiHu Branch, Taipei 10845, Taiwan
2
Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
3
Nephrology Division, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei 100233, Taiwan
4
Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
*
Author to whom correspondence should be addressed.
Received: 30 October 2020 / Revised: 11 December 2020 / Accepted: 11 December 2020 / Published: 21 December 2020
Uremic vascular calcification (VC) commonly occurs during advanced chronic kidney disease (CKD) and significantly increases cardiovascular morbidity and mortality. Uremic toxins are integral within VC pathogenesis, as they exhibit adverse vascular influences ranging from atherosclerosis, vascular inflammation, to VC. Experimental removal of these toxins, including small molecular (phosphate, trimethylamine-N-oxide), large molecular (fibroblast growth factor-23, cytokines), and protein-bound ones (indoxyl sulfate, p-cresyl sulfate), ameliorates VC. As most uremic toxins share a gut origin, interventions through gastrointestinal tract are expected to demonstrate particular efficacy. The “gastrointestinal decontamination” through the removal of toxin in situ or impediment of toxin absorption within the gastrointestinal tract is a practical and potential strategy to reduce uremic toxins. First and foremost, the modulation of gut microbiota through optimizing dietary composition, the use of prebiotics or probiotics, can be implemented. Other promising strategies such as reducing calcium load, minimizing intestinal phosphate absorption through the optimization of phosphate binders and the inhibition of gut luminal phosphate transporters, the administration of magnesium, and the use of oral toxin adsorbent for protein-bound uremic toxins may potentially counteract uremic VC. Novel agents such as tenapanor have been actively tested in clinical trials for their potential vascular benefits. Further advanced studies are still warranted to validate the beneficial effects of gastrointestinal decontamination in the retardation and treatment of uremic VC. View Full-Text
Keywords: aortic calcification; chronic kidney disease; chronic kidney disease-mineral bone disorder; indoxyl sulfate; vascular calcification; vascular smooth muscle cell; oral adsorbent; uremic toxin aortic calcification; chronic kidney disease; chronic kidney disease-mineral bone disorder; indoxyl sulfate; vascular calcification; vascular smooth muscle cell; oral adsorbent; uremic toxin
Show Figures

Figure 1

MDPI and ACS Style

Chao, C.-T.; Lin, S.-H. Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins. Toxins 2020, 12, 812. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins12120812

AMA Style

Chao C-T, Lin S-H. Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins. Toxins. 2020; 12(12):812. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins12120812

Chicago/Turabian Style

Chao, Chia-Ter; Lin, Shih-Hua. 2020. "Uremic Vascular Calcification: The Pathogenic Roles and Gastrointestinal Decontamination of Uremic Toxins" Toxins 12, no. 12: 812. https://0-doi-org.brum.beds.ac.uk/10.3390/toxins12120812

Find Other Styles
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

1
Search more from Scilit
 
Search
Back to TopTop