Nutraceuticals as a potential adjunct therapy toward improving vascular health in CKD.

Abstract

C Chronic kidney disease (CKD) is a major public health epidemic and increases risk for developing cardiovascular disease (CVD). Vascular dysfunction is a major independent risk factor toward increased risk for CVD in CKD. Several mechanisms have been postulated to result in vascular dysfunction in CKD, including oxidative stress mediated inflammation by redox imbalance and reduced nitric oxide (NO) bioavailability and synthesis. Therefore, strategies that decrease oxidative stress and/or increasing NO bioactivity may have major clinical implications towards improving vascular health and reducing the burden of CVD in CKD. Nutraceutical therapy in the form of polyphenols, dietary nitrates or selective mitochondria-targeting therapies have recently been shown to improve vascular function by reducing oxidative stress and/or increasing NO bioavailability and synthesis. This review therefore, highlights these three emerging nutraceuticals recently implicated in pathophysiological improvement of vascular function in CKD. This review also describes those pathophysiological mechanisms thought to be responsible for the beneficial effects on the vasculature, and possible experimental considerations that may exist within human CKD populations. It is clear throughout this review that human-based mechanistic preclinical and health related clinical studies are lacking regarding whether nutraceuticals do indeed improve vascular function in CKD. As such, a comprehensive, detailed, and fully integrated understanding of nutraceuticals and vasculature function are necessary in patients with CKD. Many opportunities exist for original mechanistic and therapeutic discoveries, and investigations on select nutraceuticals and their impact on vascular outcomes in patients with CKD and will remain an exciting avenue of research in the future.