Epigenetics and the uremic phenotype: a matter of balance.

Epigenetics, which is the study of changes in gene expression that occur without changes in DNA sequence, is a novel discipline that has languished in the shadow of its genomic big brother. So far, studies of the epigenome have attracted little interest in nephrology. Chronic kidney disease is an example of complex disease in which the phenotype arises from a combination of environmental and heritable factors. Evidence suggests that the contribution made by the environment may be mediated via modifications of the epigenome. In the uremic milieu, several features such as inflammation, dyslipidemia, hyperhomocysteinema, oxidative stress as well as vitamin and nutritional deficiencies may affect aberrant global DNA methylation. However, as hyperhomocysteinemia seems to promote global DNA hypomethylation and persistent inflammation DNA hypermethylation, the effects of the uremic milieu on aberrant global DNA methylation may be complex and context-sensitive. It should be emphasized that in analogy to the unspecific nature of fever, aberrant global DNA methylation is only a sign of a generalized epigenetic dysregulation. Thus, to provide better understanding of the effects of aberrant DNA methylation on the uremic phenotype, further studies evaluating site-specific information on methylation in various candidate genes are needed. The science of epigenetics may not only uncover etiologic and pathogenic mechanisms in uremia, but may also be of help to develop novel treatment strategies targeting the unacceptable high death risk in cardiovascular complications in this patient population.