How To Maintain & Improve Healthy Kidney Function

Kidney diseases are among the top ten common health conditions and cause of death based on statistics provided by NKUDIC. Kidney diseases sometimes can go unnoticed for a long time affecting the kidney tissue gradually without manifesting any symptoms or problems up until they are at only 10 % of their performance. In recent years the number of cases with kidney disease has doubled which is partly related to an increase in conditions such as high blood pressure and diabetes that damage the kidney's tiny blood vessels. The good news is that routine checkups, dietary adjustment, and integrative medicine can be helpful to optimize kidneys health.

The kidneys are a pair of bean-shaped organs with the size of your fist, located on both sides of the spine in the back of the abdominal cavity near the base of the ribcage.

Kidneys are one of the critical biological filtration systems in the body. Kidneys filter the blood, remove the wastes from it and adjust blood's minerals, electrolytes (such as Sodium and Potassium), and water to be kept within precise levels necessary to support normal physiology. Kidneys are curtailed in balancing water and fluid levels, regulating blood pressure, eliminating waste, producing hormones, maintaining PH, and metabolizing toxins and drugs. All of the blood in the body passes through the kidneys several times a day.

Impairment in kidney function can be the potential cause of other systemic conditions, thus keeping good kidney health would be one of the important aspects of a living long and healthy life.

Kidneys' curtail functions

The main structural units of kidneys are called "nephron". Each kidney contains about 1 million of these units. Nephrons act as filters that allow some minerals, certain small molecules, and water pass while stop bigger molecules, proteins, and blood cells. What has passed through the first phase of filtration, will get to the next part called renal tubules; here specialized cells re-absorb needed electrolytes and some water while letting go of the waste, remaining water, and electrolytes as urine to the collecting ducts and eventually to the bladder.

Healthy Kidneys maintain blood volume and optimal tissue hydration by retaining or excreting water and electrolytes. Dehydration triggers the central nervous system to produce antidiuretic hormone signaling kidneys to retain water, on the other hand; a high volume of water in the blood will stop the production of this hormone so kidneys excrete the extra water.

Our body at all times requires maintaining a very specific level of electrolytes and minerals including sodium, potassium, chloride, magnesium, calcium, and bicarbonate to maintain proper functions including but not limited to nerve signaling, muscle contractions, bone and skeletal strength, and variety of enzymatic reactions. Highly specialized cells in renal tubules are responsible to selectively absorb, excrete, or exchange electrolytes to keep the proper balance of electrolytes in the blood.

Regulating blood pressure is also dependent on proper kidney function. Low blood pressure is detected by a group of specialized cells in kidneys and triggers them to produce a hormone called renin. Renin consequently promotes the production of two other hormones, Angiotensin II which constricts blood vessels elevating blood pressure, and Aldosterone by Adrenal glands to encourage re-absorption of sodium and water, increasing blood volume and pressure.

Kidneys are the final activating site for vitamin D. Vitamin D from food source or skin synthesis is biologically inactive. the active form of Vitamin D ( D3) is produced via two steps enzymatic conversion (hydroxylation) first in the liver and then in the kidneys. Most mammals can synthesize Vitamin D at the exposure of sufficient sunlight. D3 plays a major role in regulating calcium and phosphorus concentration, promoting healthy growth, bone and teeth formation and strength, normal cell growth, neuromuscular activities, immune function, and reducing inflammation.

Kidneys are also involved in blood cell formation. Kidneys produce erythropoietin hormone which signals the bone marrow to produce red blood cells.

Kidneys filter and provide the ultimate excretion of other wastes, such as excess hormones, vitamins, toxins, and drug metabolites. Kidneys' Tubule cells contain many of the same detoxification enzymes as liver cells.

What can affect the health of the kidneys?

Cause number one to the kidney disease is diabetes regardless of being type 1 or type 2. High blood sugar naturally results in a high level of sugar metabolites that are impacting the molecular shapes of proteins, lipids, and nucleic acids; plus, exhibiting inflammatory and oxidative activities. These metabolites gradually damage the specialized cells of nephrons and nephrons' sensitive circulatory system just like other arteries and veins across the body. Studies support that minimizing the formation of these metabolites substantially will delay and reduce the kidney dysfunction and nephropathy.

The second most damaging cause to the kidney is High Blood Pressure (Hypertension). High blood pressure damages blood vessels in the kidneys which compromises the filtration process. At the same time, the damaged kidneys become less and less capable of regulating blood pressure, and that further worsens hypertension.

Metabolic syndrome, insulin resistance, and obesity are all are underlying causes of kidney disease. Metabolic syndrome consists of a combination of conditions that cause cardiovascular disease, kidney diseases as well as increased inflammation and oxidative effects. These conditions include obesity, high blood pressure, improper blood lipid profile (High LDL cholesterol, High triglycerides, and low HDL cholesterol), insulin resistance, borderline diabetes, or high fast blood sugar. Statistical studies show that individuals with metabolic syndrome are twice likely to develop kidney disease. Obesity is considered an independent risk factor to kidney disease regardless of the presence of high blood pressure and diabetes. Kidney disease progresses much rapidly in obese individuals, however, studies suggest those damages might be reversible by weight loss.

Low thyroid function or Hypothyroidism also impacts the kidneys' function by lowering the kidney circulation and altering the filtration of sodium. Hypothyroid cases without symptoms of hypothyroidism may benefit more from boosting their thyroid function.

Overactive Adrenal and high cortisol level, also negatively impacts the kidneys. High cortisol level is associated with salt and water retention. This may interfere with high blood pressure treatment as well. High cortisol is shown to cause other urine abnormalities, and it may encourage kidney stone formation.

Gastrointestinal health plays an important role in maintaining healthy kidneys. Imbalance intestinal microflora(dysbiosis) may cause an increase in the number of uremic toxins. Such uremic toxins not only affect the kidneys, but also cause an increase in intestinal permeability so more toxins and allergens get through the blood, and initiate inflammation, allergies, immunity concerns, cardiovascular conditions, and more. The population of Intestinal microflora adapts to the type of diet and food consumed. Higher fiber foods and an alkaline diet will help to improve the microbiome. Based on the studies Probiotics and prebiotics help with the elimination of uremic toxins.

Certain medications such as anti-inflammatory drugs, certain antibiotics, and chemotherapy are all impacting the health of kidneys. Acetaminophen is a widely used over the counter anti-inflammatory medication which has been shown to damage the kidneys' filtration and blood vessels.

The agricultural toxins such as pesticides, toxic solvents, and some heavy metals including mercury, cadmium, and lead cause damage to the kidneys. This is particularly should be very important for those who work in such environments, often consume food with those contaminations, or suffer from kidney disease at some level.

Consuming foods that cause higher acidity metabolites in the blood can negatively impact the kidney's health. As mentioned earlier one of the important jobs of the kidneys is to maintain the blood PH level at the optimal range at all times. So kidneys must eliminate those acidic metabolites and that over time cause damage to the kidneys. Taking alkaline foods from vegetables and fruits, or alkalizing formulas will help to reduce the acid load and neutralize some of those acidic metabolites.

What can help to promote kidney health?

Adjusting to a diet low in fat, dairy, red meat, salt, and sugar, limiting the protein intake while increasing plant-based foods and vegetables are a few important factors for maintaining healthy kidney function. Limiting dietary sodium is one of the main keys to kidney-related conditions.

Glucose, fructose, and sucrose are highly damaging to the kidneys. Fructose also contributes to higher uric acid which compromises the kidneys. Based on studies those with diets high in saturated fats have lost more of their kidney function than those with low saturated fat diets. Mono-saturated fats promote healthier blood lipid profile, modulate blood pressure, and improve blood sugar.

Animal protein is richer in phosphorus which is not suitable for kidney health, however; taking a moderate amount of calcium helps to increase the blood ratio of calcium to phosphorus reducing the negative impacts phosphorus. Animal protein also results in high acidic metabolites that should be eliminated by kidneys.

The active form of vitamin B6, Pyridoxal 5’-phosphate (P5P), prevents the formation of sugar metabolites. Sugar metabolites as it was mentioned above cause damage to kidneys' circulation, and able to create inflammation and oxidative stress. P5P may help maintain kidney health in diabetics. In diabetic animal models, P5P administration reduced those end metabolites, protein loss from urine, tissue fibrosis of kidneys, and progression of diabetic kidney disease.

Benfotiamine (active fat-soluble form of vitamin B1) is found to be able to block the formation of sugar metabolites and reduce the impacts of high blood sugar on kidneys, nerves, and eyes. Benfotiamine reduces the urine albumin(protein) and the toxic effects of drugs and chemotherapy on kidneys.

CoQ10 has shown to be beneficial for kidneys. CoQ10 modulates blood pressure. Results from different trails are indicative of supplementation with Coq10 at 100-120 mg daily within 4-12 weeks helped to reduce both systolic and diastolic blood pressure. 200 mg intake of CoQ10 in diabetic participant showed reduction in blood pressure and Hemoglobin A1c (Diabetes indicator). In other studies CoQ10 provided protective function for kidneys against toxins. Coq10 performs as an antioxidant and reduce the oxidative effects on the kidney tissue and participants showed mild reduction in Creatinine Clearance Rate.

In animal studies, administration of NAC (N-acetyl cysteine) helped reducing the kidney damage caused by heavy metal toxicity by improving the renal circulation and lowering the urine protein. In human studies patients undergoing haemodialysis were given 600mg of NAC twice daily for 12 weeks and showed significant reduction in their serum inflammatory markers. Other data suggest that NAC may be helpful in reducing the effects of chemo toxicity on kidneys.

Magnesium along with potassium citrate considered as urine alkalizer and used to prevent renal stone formation. Magnesium also helps to improve blood pressure. Magnesium deficiency is commonly observed in diabetes and metabolic syndrome.

L-Carnitine deficiency is a common condition for those under dialysis disturbing function of the heart muscle and other muscles which is often demonstrated as severe fatigue. Usually, the intravenous L Carnitine is used to prevent its deficiency. Studies show intravenous or oral intake of L carnitine equally is beneficial, plus it reduces the blood inflammatory markers such as CRP as well as the LDL.

Kidneys convert vitamin D to its active form, so kidney disease can lead to vitamin D deficiency. In animal studies, vitamin D showed a protective effect on the kidneys by decreasing kidney inflammation, fibrosis, and cell death. In humans, vitamin D may reduce protein loss in urine and improve immune function.

A higher dose of omega 3 essential fatty acids is found to be effective in reducing blood pressure. Other evidence from patients with chronic kidney disease showed that omega-3 fatty acids could reduce the urine protein, reduce inflammation, and serum triglycerides.

Improving the population of intestinal microflora has been proven to prevent the formation of uremic toxins and promote their removal from the blood. Uremic toxins negatively impact kidney function and cause kidney damage in chronic kidney disease.

Silymarin an active compound extracted from milk thistle exhibited a protective effect against renal toxicity by drugs, other toxins, and chemotherapy. Silymarin was also found to be effective against the oxidative damage caused by high blood sugar in diabetes.

A variety of research suggests antioxidants such as resveratrol, green tea extract ( EGCG), curcumin, alpha-lipoic acid, and vitamin E provide protection against oxidative damage caused by high blood sugar, improve renal circulation, reduce the effects of toxins on kidneys (nephrotoxicity), and lower inflammatory markers.

What are the usual indicators of kidney conditions?

Early detection and treatment of kidney disease are the keys to delay or stop its progression to the advanced stages. Some simple tests for kidneys are performed to detect any abnormality. People who have an increased risk for chronic kidney disease must require these tests. You may have an increased risk for kidney disease if you are older, have diabetes, have high blood pressure, or have a family member who has chronic kidney disease.

If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid starts building up in the body. Although many forms of kidney disease do not exhibit symptoms until late in the course of the disease, there are some signs of kidney disease that should be taken seriously including; high blood pressure, abnormal kidney function indicators such as creatinine, urea, blood, or protein in the urine, frequent urinary infection, painful urination, frequent urination, puffiness around the eyes and swelling of hands or feet.

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Select References:

1.Ordunez P, Martinez R, Reveiz L, Chapman E, Saenz C, Soares da Silva A, Becerra F. Chronic Kidney Disease Epidemic in Central America: Urgent Public Health Action Is Needed amid Causal Uncertainty. PLoS neglected tropical diseases. Aug 2014;8(8):e3019.

2.Al-Awqati Q, Barasch J, Goldman L (ed.), SchaferAI (ed.). Goldman's Cecil Medicine, Twenty-Fourth Edition. Chapter 117: Structure and Function of the Kidneys; 716-720. Copyright 2012 Saunders, an imprint of Elsevier, Inc. Available at: www.clinicalkey.com Accessed: 6/9/2014.

3.Underwood PC, Adler GK. The renin angiotensin aldosterone system and insulin resistance in humans. Current hypertension reports. Feb 2013;15(1):59-70.

4.Alpern RJ, Sakhaee K. The clinical spectrum of chronic metabolic acidosis: homeostatic mechanisms produce significant morbidity. American journal of kidney diseases : the official journal of the National Kidney Foundation. Feb 1997;29(2):291-302.

5.Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. Journal of the American Society of Nephrology : JASN. Jul 2005;16(7):2134-2140.

6.Chen J, Muntner P, Hamm LL, et al. The Metabolic Syndrome and Chronic Kidney Disease in U.S. Adults. Ann Intern Med. 2004;140(3):167–74

7.Bohlender JM, Franke S, Stein G, and Wolf G. Advanced glycation end products and the kidney. American journal of physiology. Renal physiology. 2005;289(4):F645–59

8.Davis KE, Prasad C, Vijayagopal P, Juma S, Imrhan V. Advanced Glycation End Products, Inflammation, and Chronic Metabolic Diseases:Links in a Chain? Critical reviews in food science and nutrition. Sep 26 2014.

9.Calhoun DA. Hyperaldosteronism as a common cause of resistant hypertension. Annu. Rev. Med. 2013;64:233–47

10.Dash A, Maiti R, Bandakkanavar TK, Bhaskar A, Prakash J, Pandey BL. Prophylactic Add-on Antiplatelet Therapy in Chronic Kidney Disease With Type 2 Diabetes Mellitus: Comparison Between Clopidogrel and Low-dose Aspirin. International journal of preventive medicine. Aug 2013;4(8):902-910.

11.AHA. American Heart Association. Kidney Damage and High Blood Pressure. Available at: http://www.heart.org/HEARTORG/Conditions/HighBloo... Last updated 9/11/2014a. Accessed 8/10/2014.

12.Nashar K, Egan BM. Relationship between chronic kidney disease and metabolic syndrome: current perspectives. Diabetes, metabolic syndrome and obesity : targets and therapy. 2014;7:421-435.

13.Guarnieri G, Zanetti M, Vinci P, Cattin MR, Pirulli A, Barazzoni R. Metabolic syndrome and chronic kidney disease. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. Sep 2010;20(5 Suppl):S19-23.

14.MedicineNet. Metabolic Syndrome: How is metabolic syndrome defined? Available at: http://www.medicinenet.com/metabolic_syndrome/art... 9/19/2014. Accessed 9/19/2014.

15.Kopple JD. Obesity and chronic kidney disease. J Ren Nutr. 2010;20(5 Suppl):S29-30.

16.Hall ME, do Carmo JM, da Silva AA, Juncos LA, Wang Z, Hall JE. Obesity, hypertension, and chronic kidney disease. International journal of nephrology and renovascular disease. 2014;7:75-88.

17.Eknoyan G. Obesity and chronic kidney disease. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia. 2011;31(4):397-403.

18.Hataya Y, Igarashi S, Yamashita T, and Komatsu Y. Thyroid hormone replacement therapy for primary hypothyroidism leads to significant improvement of renal function in chronic kidney disease patients. Clinical and experimental nephrology. 2013;17(4):525–31

19.Kim EO, Lee IS, Choi YA, et al. Unresolved subclinical hypothyroidism is independently associated with progression of chronic kidney disease. Int J Med Sci. 2014;11(1):52–9

20.Lameire N, Kruse V, Rottey S. Nephrotoxicity of anticancer drugs--an underestimated problem? Acta clinica Belgica. 2011;66(5):337–45

21.Nderitu P, Doos L, Jones PW, Davies SJ, Kadam UT. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Family practice. Jun 2013;30(3):247-255.

22.Ozkaya O, Genc G, Bek K, Sullu Y. A case of acetaminophen (paracetamol) causing renal failure without liver damage in a child and review of literature. Renal failure. 2010;32(9):1125-1127.

23.Rahman S, Malcoun A. Nonsteroidal antiinflammatory drugs, cyclooxygenase-2, and the kidneys. Primary care. Dec 2014;41(4):803-821.

24.Patrick L. Lead toxicity part II: the role of free radical damage and the use of antioxidants in the pathology and treatment of lead toxicity. Altern Med Rev. 2006;11(2):114–27

25.Patrick L. Mercury toxicity and antioxidants: Part 1: role of glutathione and alpha-lipoic acid in the treatment of mercury toxicity. Altern Med Rev. 2002;7(6):456–71

26.Bellizzi V. Low-protein diet or nutritional therapy in chronic kidney disease? Blood purification. 2013;36(1):41–6

27.Eyre S, Attman PO, Haraldsson B. Positive effects of protein restriction in patients with chronic kidney disease. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. May 2008;18(3):269-280.

28.Chrysohoou C, Panagiotakos DB, Pitsavos C, Skoumas J, Zeimbekis A, Kastorini CM, Stefanadis C. Adherence to the Mediterranean diet is associated with renal function among healthy adults: the ATTICA study. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. May 2010;20(3):176-184

29.Odermatt A. The Western-style diet: a major risk factor for impaired kidney function and chronic kidney disease. AJP: Renal Physiology. 2011;301(5):F919–31

30.Goraya N, Simoni J, Jo C, Wesson DE. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney international. Jan 2012;81(1):86-93.

31.Goraya N, Wesson DE. Dietary management of chronic kidney disease: protein restriction and beyond. Current opinion in nephrology and hypertension. Nov 2012;21(6):635-640.

32.Frassetto LA, Morris RCJ, and Sebastian A. Dietary sodium chloride intake independently predicts the degree of hyperchloremic metabolic acidosis in healthy humans consuming a net acid-producing diet. American journal of physiology. Renal physiology. 2007;293(2):F521–5

33.Kumar PA, Chitra PS, Reddy GB. Metabolic syndrome and associated chronic kidney diseases: nutritional interventions. Reviews in endocrine & metabolic disorders. 2013;14(3):273–86

34.Murray MD, Brater DC. Renal toxicity of the nonsteroidal anti-inflammatory drugs. Annual review of pharmacology and toxicology. 1993;33:435-465.

35.Babaei-Jadidi R, Karachalias N, Ahmed N, Battah S, and Thornalley PJ. Prevention of incipient diabetic nephropathy by high-dose thiamine and benfotiamine. Diabetes. 2003;52(8):2110–20

36.Harisa GI. Benfotiamine enhances antioxidant defenses and protects against cisplatin-induced DNA damage in nephrotoxic rats. J. Biochem. Mol. Toxicol. 2013;27(8):398–405

37.Karachalias N, Babaei-Jadidi R, Rabbani N, and Thornalley PJ. Increased protein damage in renal glomeruli, retina, nerve, plasma and urine and its prevention by thiamine and benfotiamine therapy in a rat model of diabetes. Diabetologia. 2010;53(7):1506–16

38.Kihm LP, Müller-Krebs S, Klein J. Benfotiamine protects against peritoneal and kidney damage in peritoneal dialysis. J. Am. Soc. Nephrol. 2011;22(5):914–26

39.Lacour B, Parry C, Drüeke T, et al. Pyridoxal 5'-phosphate deficiency in uremic undialyzed, hemodialyzed, and non-uremic kidney transplant patients. Clin. Chim. Acta. 1983;127(2):205–15

40.Nakamura S, Li H, Adijiang A, Pischetsrieder M, and Niwa T. Pyridoxal phosphate prevents progression of diabetic nephropathy. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2007;22(8):2165–74

41.Fouad AA, Al-Sultan AI, Refaie SM, and Yacoubi MT. Coenzyme Q10 treatment ameliorates acute cisplatin nephrotoxicity in mice. Toxicology. 2010;274(1-3):49–56

42.Mori TA, Burke V, Puddey I, et al. The effects of [omega]3 fatty acids and coenzyme Q10 on blood pressure and heart rate in chronic kidney disease: a randomized controlled trial. J. Hypertens. 2009;27(9):1863–72

43.Schwalfenberg GK. The alkaline diet: is there evidence that an alkaline pH diet benefits health? Journal of environmental and public health. 2012;2012:727630.

44.Barbagallo M, Dominguez LJ, Galioto A, Pineo A, Belvedere M. Oral magnesium supplementation improves vascular function in elderly diabetic patients. Magnesium research : official organ of the International Society for the Development of Research on Magnesium. Sep 2010;23(3):131-137.

45.Kisters K. Oral magnesium supplementation improves borderline hypertension. Magnesium research : official organ of the International Society for the Development of Research on Magnesium. Mar 2011;24(1):17; author reply 18.

46.Munekage E, Takezaki Y, Hanazaki K. [Shortage and metabolic disturbance of magnesium in diabetic patients and significance of magnesium replacement therapy]. Clinical calcium. Aug 2012;22(8):1235-1242.

47.Dong JY, Xun P, He K, Qin LQ. Magnesium intake and risk of type 2 diabetes: meta-analysis of prospective cohort studies. Diabetes care. Sep 2011;34(9):2116-2122.

48.Cunningham J, Rodríguez M, Messa P. Magnesium in chronic kidney disease Stages 3 and 4 and in dialysis patients. Clinical Kidney Journal. 2012;5(Suppl 1):i39-i51.

49.Chaudhary DP, Sharma R, Bansal DD. Implications of magnesium deficiency in type 2 diabetes: a review. Biological trace element research. May 2010;134(2):119-129.

50.Fjellstedt E, Denneberg T, Jeppsson JO, Tiselius HG. A comparison of the effects of potassium citrate and sodium bicarbonate in the alkalinization of urine in homozygous cystinuria. Urological research. Oct 2001;29(5):295-302.

51.Rush-Monroe K. Kidney Function Can Be Assessed by Measuring Cystatin C in Blood. University of California, San Francisco. www.ucsf.edu/news/2013/09/108666/relations.... 9/4/2013. Accessed 1/27/2015.

52.Jaipakdee S, Prasongwatana V, Premgamone A, Reungjui S, Tosukhowong P, Tungsanga K, . . . Sriboonlue P. The effects of potassium and magnesium supplementations on urinary risk factors of renal stone patients. Journal of the Medical Association of Thailand = Chotmaihet thangphaet. Mar 2004;87(3):255-263.

53.Ho MJ, Bellusci A, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2009;(4):CD007435

54.Ishikawa A, Homma Y. Beneficial effect of ubiquinol, the reduced form of coenzyme Q10, on cyclosporine nephrotoxicity. International braz j urol : official journal of the Brazilian Society of Urology. Mar-Apr 2012;38(2):230-234; discussion 234.

55.Hodgson JM, Watts GF, Playford DA, Burke V, and Croft KD. Coenzyme Q10 improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr. 2002;56(11):1137–42

56.Hojs R, Bevc S, Antolinc B, Gorenjak M, Puklavec L. Serum cystatin C as an endogenous marker of renal function in the elderly. International journal of clinical pharmacology research. 2004;24(2-3):49-54.

57.Mariani LH, White MT, Shults J, et al. Increasing use of vitamin D supplementation in the chronic renal insufficiency cohort study. Journal of renal nutrition: the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2014;24(3):186–93

58.Kim CS, Kim SW. Vitamin D and chronic kidney disease. Korean J Intern Med. 2014;29(4):416

59.Chen Y, Abbate M, Tang L. L-Carnitine supplementation for adults with end-stage kidney disease requiring maintenance hemodialysis: a systematic review and meta-analysis. American Journal of Clinical Nutrition. 2014;99(2):408–22

60.Eknoyan G, Latos DL, Lindberg J, National Kidney Foundation Carnitine Consensus Conference. Practice recommendations for the use of L-carnitine in dialysis-related carnitine disorder. National Kidney Foundation Carnitine Consensus Conference. Am J Kidney Dis. 2003;41(4):868–76.

61.Geleijnse JM, Giltay EJ, Grobbee DE, Donders ART, and Kok FJ. Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. J. Hypertens. 2002;20(8):1493–9

62.Gopinath B, Harris DC, Flood VM, Burlutsky G, and Mitchell P. Consumption of long-chain n-3 PUFA, α-linolenic acid and fish is associated with the prevalence of chronic kidney disease. Br J Nutr. 2011;105(9):1361–8

63.Huang X, Lindholm B, Stenvinkel P, Carrero JJ. Dietary fat modification in patients with chronic kidney disease: n-3 fatty acids and beyond. Journal of nephrology. Nov-Dec 2013;26(6):960-974.

64.Ramezani A, Raj DS. The gut microbiome, kidney disease, and targeted interventions. Journal of the American Society of Nephrology : JASN. Apr 2014;25(4):657-670.

65.Sabatino A, Regolisti G, Brusasco I, Cabassi A, Morabito S, Fiaccadori E. Alterations of intestinal barrier and microbiota in chronic kidney disease. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. Sep 4 2014.

66.Vitetta L, Gobe G. Uremia and chronic kidney disease: the role of the gut microflora and therapies with pro- and prebiotics. Molecular nutrition & food research. May 2013;57(5):824-832.

67.Vitetta L, Linnane AW, Gobe GC. From the gastrointestinal tract (GIT) to the kidneys: live bacterial cultures (probiotics) mediating reductions of uremic toxin levels via free radical signaling. Toxins. Nov 2013;5(11):2042-2057.

68.A.D.A.M. MedlinePlus web page. Acidosis. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00021... Last updated 11/7/2013a. Accessed 10/21/2014.

69.Anders HJ, Andersen K, Stecher B. The intestinal microbiota, a leaky gut, and abnormal immunity in kidney disease. Kidney international. Jun 2013;83(6):1010-1016.

70.Evenepoel P, Meijers BK, Bammens BR, Verbeke K. Uremic toxins originating from colonic microbial metabolism. Kidney international. Supplement. Dec 2009(114):S12-19.

71.El-Shitany NA, El-Haggar S, El-desoky K. Silymarin prevents adriamycin-induced cardiotoxicity and nephrotoxicity in rats. Food and chemical toxicology : an international journal published for the British Industrial Biological Research Association. Jul 2008;46(7):2422-2428.

72.Abenavoli L, Capasso R, Milic N, Capasso F. Milk thistle in liver diseases: past, present, future. Phytother Res. 2010;24(10):1423-32.

73.Karimi G, Ramezani M, Tahoonian Z. Cisplatin nephrotoxicity and protection by milk thistle extract in rats. Evidence-based complementary and alternative medicine : eCAM. Sep 2005;2(3):383-386.

74.Gaedeke J, Fels LM, Bokemeyer C, Mengs U, Stolte H, Lentzen H. Cisplatin nephrotoxicity and protection by silibinin. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. Jan 1996;11(1):55-62.

75.Abdel-Raheem IT, El-Sherbiny GA, Taye A. Green tea ameliorates renal oxidative damage induced by gentamicin in rats. Pakistan journal of pharmaceutical sciences. Jan 2010;23(1):21-28.

76.Khan SA, Priyamvada S, Khan W, Khan S, Farooq N, and Yusufi ANK. Studies on the protective effect of green tea against cisplatin induced nephrotoxicity. Pharmacol. Res. 2009;60(5):382–91

77.Bae EH, Lee J, Ma SK, et al. alpha-Lipoic acid prevents cisplatin-induced acute kidney injury in rats. Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2009;24(9):2692–700

78.Balakumar P, Rohilla A, Krishan P, Solairaj P, and Thangathirupathi A. The multifaceted therapeutic potential of benfotiamine. Pharmacol. Res. 2010;61(6):482–8

79.Saddadi F, Alatab S, Pasha F, Ganji MR, Soleimanian T. The effect of treatment with N-acetylcysteine on the serum levels of C-reactive protein and interleukin-6 in patients on hemodialysis. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia. Jan 2014;25(1):66-72.

80.Bertelli AAE, Migliori M, Panichi V. Resveratrol, a component of wine and grapes, in the prevention of kidney disease. Ann N Y Acad Sci. 2002;957:230–8

81.Holthoff JH, Wang Z, Seely KA, Gokden N, and Mayeux PR. Resveratrol improves renal microcirculation, protects the tubular epithelium, and prolongs survival in a mouse model of sepsis-induced acute kidney injury. Kidney Int. 2012;81(4):370–8

82.Kitada M, Koya D. Renal protective effects of resveratrol. Oxid Med Cell Longev. 2013;2013:568093.

83.Leu J-G, Lin C-Y, Jian J-H, Shih C-Y, and Liang Y-J. Epigallocatechin-3-gallate combined with alpha lipoic acid attenuates high glucose-induced receptor for advanced glycation end products (RAGE) expression in human embryonic kidney cells. An. Acad. Bras. Cienc. 2013;85(2):745–52

84.Feng B, Yan X-F, Xue J-L, Xu L, and Wang H. The Protective Effects of α-Lipoic Acid on Kidneys in Type 2 Diabetic Goto-Kakisaki Rats via Reducing Oxidative Stress. Int J Mol Sci. 2013;14(4):6746–56

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Designs for Health K+2 Potassium 120 Veg Capsules	Metagenics Ceralin Forte 90 Capsules	Alpha Science Kidney Support 90 Capsules
This uniquely formulated potassium product is composed of potassium bicarbonate, because of the substantial research on its alkalinizing capacities and blood pressure support ...Read more	N-acetyl-L-Cysteine is a potent antioxidant for the maintenance of good health in individuals under oxidative stress. ...Read More	This formula relieves water retention, treats urinary tract infections, reduces inflammation of the kidneys and minimizes kidney stones. ...Read more