Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Road, London, ON, N6G 2V4, Canada.
Department of Physiology & Pharmacology, Western University, London, ON, Canada.
Curr Neurol Neurosci Rep. 2022 Nov;22(11):757-766. doi: 10.1007/s11910-022-01230-6. Epub 2022 Oct 1.
We reviewed reasons for the high cardiovascular risk (CVD) of patients with chronic kidney disease (CKD), and explored alternatives to treatment of traditional risk factors to reduce CVD in CKD.
Besides traditional risk factors, patients with CKD are exposed to uremic toxins of two kinds: systemically derived toxins include asymmetric dimethylarginine (ADMA), total homocysteine (tHcy), thiocyanate, tumor necrosis factor alpha, and interleukin 6. Gut-derived uremic toxins (GDUT), products of the intestinal microbiome, include hippuric acid, indoxyl sulfate, p-cresyl sulfate, p-cresyl glucuronide, phenylacetylglutamine, and trimethylamine N-oxide (TMAO). Cyanocobalamin is toxic in patients with CKD. Approaches to reducing plasma levels of these uremic toxins would include diet to reduce GDUT, kidney transplantation, more intensive dialysis, and vitamin therapy to lower tHcy with methylcobalamin rather than cyanocobalamin. The high CVD risk in CKD requires consideration of therapies beyond treatment of traditional risk factors.
我们回顾了慢性肾脏病（CKD）患者心血管风险（CVD）高的原因，并探讨了治疗传统危险因素以外的方法，以降低 CKD 患者的 CVD。
除了传统危险因素外，CKD 患者还会接触到两种尿毒症毒素：全身来源的毒素包括不对称二甲基精氨酸（ADMA）、总同型半胱氨酸（tHcy）、硫氰酸盐、肿瘤坏死因子-α和白细胞介素 6。肠道来源的尿毒症毒素（GDUT）是肠道微生物组的产物，包括马尿酸、吲哚硫酸、对甲酚硫酸、对甲酚葡萄糖醛酸、苯乙酰谷氨酰胺和三甲胺 N-氧化物（TMAO）。氰钴胺素在 CKD 患者中是有毒的。降低这些尿毒症毒素血浆水平的方法包括饮食以减少 GDUT、肾移植、更强化的透析以及用甲基钴胺素而不是氰钴胺素降低 tHcy 的维生素治疗。CKD 患者的 CVD 风险高，需要考虑除了治疗传统危险因素以外的治疗方法。
