Supplementation of Antioxidants in Chronic Kidney Disease: Clinical Necessity or Wishful Thinking? A Bench to Bedside Translational Research.

Chronic Kidney Disease (CKD) patients are at increased risk for atherosclerosis, cardiovascular disease (CVD), and progression to end-stage kidney disease (ESKD). This heavy CVD risk cannot be solely attributed to traditional Framingham risk factors. Oxidative stress, defined as the disruption of the balance between prooxidants and antioxidants in favor of the former, has emerged as a novel risk factor for CVD and CKD progression. Specifically, lipid peroxidation has been identified as a trigger for endothelial dysfunction, the first step towards atherogenesis, and protein oxidation has been associated with CKD progression. The oxidation of proteins and lipids starts early in CKD, increases gradually with disease progression, and is further exacerbated in ESKD due to dialysis-related factors. In order to counteract the deleterious effects of free radicals and thereby ameliorate, or delay, CV disease and progression of CKD, exogenous administration of antioxidants has been proposed. Here, we attempt to summarize existing data from experimental and clinical studies that test antioxidants for their possible beneficial effects against CVD and CKD progression, such as vitamins E and C, statins, omega-3 fatty acids, trace elements, polyphenols, and N-acetylcysteine.