Some Like it Hot: Cardioprotective Effect of Curcumin in Chronic Kidney Disease

Excerpt

Chronic kidney disease (CKD) is a progressive loss of kidney structure (i.e., proteinuria, abnormal urinary sediment, abnormalities on imaging studies) and function (i.e., glomerular filtration rate (GFR) <60 mL/min per 1.73 m²) over a period of 3 months or longer which leads to accumulation of water, waste, and toxic substances in the body that are normally excreted by the kidney [1]. The presence of CKD confers a markedly increased risk of cardiovascular disease, and in fact patients with CKD die primarily from cardiovascular complications rather than from end-stage renal failure [2, 3]. The kidney plays a central role in electrolyte balance, volume, and blood pressure regulation; all of these parameters have a significant impact on cardiovascular health [4]. If the kidneys fail to work properly, fluid builds up quickly in the lungs and heart leading to hypervolemia. This increases the workload of the heart and could lead to chronic heart failure due to volume-overload with increased central venous pressure and low systematic arterial pressure [5]. This in turn reduces net renal perfusion pressure, further reducing renal function and stimulating many neurohumoral factors such as the renin–angiotensin–aldosterone system (RAAS), the sympathetic nervous system, including the adrenals, and the arginine–vasopressin system, to maintain renal blood supply [6]. In addition, the metabolic disturbances in CKD accelerate the atherosclerotic process causing vascular calcification and stiffness leading to pressure overload. Histopathological studies indicate that capillary density is reduced in the hypertrophied myocardium, and pronounced interstitial fibrosis is a dominant feature of CKD-associated structural myocardial remodeling [5]. Furthermore, higher rates of arrhythmias and sudden death are observed in CKD due to shifts in electrolyte balance and myocardial substrate. …