Oxidative Stress in Chronic Kidney Disease

Chronic kidney disease (CKD) and especially end-stage kidney disease (ESKD) patients carry a heavy cardiovascular (CV) burden that cannot be solely attributed to the traditional, Framingham risk factors. Among others, oxidative stress is a novel, uremic-related risk factor for CV mortality and morbidity in these patients. Oxidative stress presents at early stages of CKD and is progressively aggravated, as kidney function deteriorates. In ESKD, oxidative stress is further increased and associated with adverse clinical outcomes, including deterioration and subsequent loss of residual renal function, atherosclerosis, hypertension, CV disease, and death. Compared to hemodialysis (HD), peritoneal dialysis (PD) present a lower degree of oxidative stress, mainly due to the fact that PD is a more biocompatible dialysis modality, whereas after kidney transplantation, both kidney function and oxidative stress are partially restored. In this chapter, we provide an update of the clinical epidemiology, pathophysiology and progression mechanisms, risk factors, markers, and management of oxidative stress in all stages and aspects of kidney disease.