A New Hope for Peritoneal Dialysis Patients: The Potential of Curcumin Supplementation in Reducing Uremic Toxins

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In the face of chronic kidney disease (CKD) and the challenges of peritoneal dialysis, patients often find themselves trapped in a vicious cycle of inflammation, oxidative stress, and uremia. But what if a natural remedy, hidden within the vibrant hues of turmeric, could offer a glimmer of hope?

Chronic kidney disease (CKD) is a global health burden, affecting millions of individuals worldwide.1 Patients with advanced CKD often require dialysis, with peritoneal dialysis (PD) being a common treatment modality. However, PD patients face unique challenges, including inflammation, oxidative stress, and the accumulation of uremic toxins, which contribute to poor clinical outcomes.2 In the search for novel therapeutic approaches, researchers have turned their attention to natural compounds, such as curcumin, the primary active ingredient in turmeric.3

A recent randomized controlled trial, published in the journal Clinical Nutrition ESPEN, sought to investigate the effects of curcumin supplementation on oxidative stress, inflammatory markers, and uremic toxins in CKD patients undergoing PD.4 The study, led by Drielly C M V Reis and colleagues, enrolled 48 patients who were randomized into two groups: a curcumin group, receiving three capsules of 500 mg Curcuma longa extract (98.42% total curcuminoids) daily, and a placebo group, receiving three capsules of 500 mg starch daily, for a period of 12 weeks.

The researchers employed a comprehensive array of techniques to assess the impact of curcumin supplementation on various biomarkers. They evaluated the transcriptional expression levels of Nrf2, HOX-1, and NF-κB in peripheral blood mononuclear cells (PBMCs) using quantitative real-time PCR. Oxidative stress was assessed by measuring malondialdehyde (MDA) and total thiol (T-SH) levels, while inflammatory markers TNF-α and IL-6 were quantified using ELISA. Additionally, the study measured the plasma levels of p-cresyl sulfate, a uremic toxin, using high-performance liquid chromatography (HPLC) with fluorescent detection.

The results of the study showed that after 12 weeks, the curcumin group experienced a significant reduction in plasma MDA levels (p = 0.01), indicating a decrease in lipid peroxidation, while no change was observed in the placebo group. Although the difference between the groups at the endpoint was not statistically significant, there was a trend towards reduced p-cresyl sulfate levels in the curcumin group compared to the placebo group (p = 0.07). However, the study did not find significant changes in protein thiol concentrations, mRNA expression of Nrf2, HOX-1, NF-κB, or plasma cytokine levels.

The findings of this study suggest that curcumin supplementation may have potential benefits for CKD patients undergoing PD by attenuating lipid peroxidation and possibly reducing uremic toxin levels. These results are in line with previous studies that have demonstrated the antioxidant and anti-inflammatory properties of curcumin in various disease states.5 The reduction in lipid peroxidation is particularly noteworthy, as oxidative stress has been implicated in the pathogenesis of CKD and its complications.6

While the study did not find significant changes in all measured parameters, the trend towards reduced p-cresyl sulfate levels in the curcumin group is encouraging. P-cresyl sulfate is a uremic toxin that has been associated with adverse outcomes in CKD patients, including cardiovascular disease and mortality.7 By potentially reducing the levels of this toxin, curcumin supplementation may offer a novel approach to mitigating the harmful effects of uremia in PD patients.

However, it is important to acknowledge the limitations of this study. The sample size was relatively small, with only 24 patients completing the full 12-week intervention. Additionally, the study was single-blind, which may introduce potential bias. Further research with larger sample sizes and double-blind designs is needed to confirm and expand upon these findings.

In conclusion, the randomized controlled trial by Reis et al. provides valuable insights into the potential of curcumin supplementation as a natural therapeutic option for CKD patients undergoing PD. By demonstrating the ability of curcumin to reduce lipid peroxidation and possibly lower uremic toxin levels, this study opens the door for further exploration of the role of curcumin in improving outcomes for this patient population. As the global burden of CKD continues to rise, the identification of safe and effective interventions, such as curcumin supplementation, may offer hope for breaking the vicious cycle of inflammation, oxidative stress, and uremia in PD patients.

Learn more about the therapeutic value of curcumin on our database on the subject here.

For natural approaches to chronic kidney disease (CKD) visit our database on the subject here.


References

1. Jager, Kitty J., Csaba Kovesdy, Rajiv Langham, Mark Rosenberg, Vivekanand Jha, and Carmine Zoccali. "A Single Number for Advocacy and Communication—Worldwide More than 850 Million Individuals Have Kidney Diseases." Kidney International 96, no. 5 (November 1, 2019): 1048-50. https://www.kidney-international.org/article/S0085-2538(19)30989-0/fulltext.

2. Zhang, Hao, Yanting Zheng, Yonglong Zhang, Yingxue Xin, and Yaning Li. "The Characteristics of Inflammation and Oxidative Stress in Patients with Chronic Kidney Disease and Peritoneal Dialysis." Scientific Reports 11, no. 1 (April 9, 2021): 7924. https://www.nature.com/articles/s41598-021-87687-w.

3. Kunnumakkara, Ajaikumar B., Devivasha Bordoloi, Ganesan Padmavathi, Javadi Monisha, Nand Kishor Roy, Sahdeo Prasad, and Bharat B. Aggarwal. "Curcumin, the Golden Nutraceutical: Multitargeting for Multiple Chronic Diseases." British Journal of Pharmacology 174, no. 11 (2017): 1325-48. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664031/.

4. Reis, Drielly C. M. V., Livia Alvarenga, Ludmila F. M. F. Cardozo, Beatriz G. Baptista, Susane Fanton, Bruna R. Paiva, Marcelo Ribeiro-Alves, et al. "Can Curcumin Supplementation Break the Vicious Cycle of Inflammation, Oxidative Stress, and Uremia in Patients Undergoing Peritoneal Dialysis?" Clinical Nutrition ESPEN 59 (February 1, 2024): 96-106. https://www.sciencedirect.com/science/article/abs/pii/S2405457723002474.

5. Sharifi-Rad, Javad, Cristina Quispe, Jesús Herrera-Bravo, Wafa Ayed Alkhammash, Sakshi Painuli, Manoj Kumar, Miquel Martorell, et al. "A Pharmacological Perspective on Plant-Derived Bioactive Molecules for Epilepsy." Neurochemical Research 46, no. 9 (September 1, 2021): 2205-25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522354/.

6. Daenen, Kathleen, Asami Andries, Djalila Mekahli, Ann Van Schepdael, Francis Jouret, and Bert Bammens. "Oxidative Stress in Chronic Kidney Disease." Pediatric Nephrology 34, no. 6 (June 1, 2019): 975-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466441/.

7. Lin, Cheng-Jui, Chih-Kuang Chuang, Tusty-Jiuan Hsieh, Yuan-Yow Chiou, Ching-Chih Hung, Mei-Yi Wu, and Hsuan-Liang Liu. "High Serum P-Cresyl Sulfate Level Is Associated with Poor Outcome of Peritoneal Dialysis Patients." Therapeutic Apheresis and Dialysis 21, no. 5 (October 2017): 466-73. https://pubmed.ncbi.nlm.nih.gov/28545705/.

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