Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10616-10625
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10616
Effects of hypoxia on bone metabolism and anemia in patients with chronic kidney disease
Chao Kan, Xu Lu, Rui Zhang
Chao Kan, Xu Lu, Department of Clinical Medicine, Changchun University of Chinese Medicine, Changchun 130000, Jilin Province, China
Rui Zhang, Department of Nephrology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai 519070, Guangdong Province, China
Author contributions: Zhang R initiated the project and gave constructive comments and suggestions for the manuscript; Kan C drafted the manuscript; Lu X provided assistance with the figures and tables; and all authors have read and approved the manuscript.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rui Zhang, PhD, Chief Physician, Department of Nephrology, Zhuhai People’s Hospital (Zhuhai Hospital Affiliated with Jinan University), No. 79 Kangning Road, Xiangzhou District, Zhuhai 519070, Guangdong Province, China. zhangruidoctor@163.com
Received: May 7, 2021
Peer-review started: May 7, 2021
First decision: July 26, 2021
Revised: August 12, 2021
Accepted: October 25, 2021
Article in press: October 25, 2021
Published online: December 6, 2021
Processing time: 207 Days and 0.4 Hours
ARTICLE HIGHLIGHTS
Research background

Abnormal bone metabolism and renal anemia seriously affect the prognosis of patients with chronic kidney disease (CKD). Currently, there are few studies on the evaluation of their mutual connection. With the availability of hypoxia-inducible factor (HIF) stabilizers, more therapeutic choices for renal anemia are expected in the future. However, the effects posed by the hypoxic environment on abnormal bone metabolism remain incompletely understood. If we can find evidence that HIF could improve both complications, it will be a great advantage to improve the prognosis of patients with CKD.

Research motivation

The purpose of this article is to summarize the relationship between renal anemia and abnormal bone metabolism, and to discuss the influence of hypoxia on bone metabolism, in order to provide a new way of thinking for the future studies on the treatment of CKD complications.

Research objectives

To clarify the bidirectional relationship between anemia and abnormal bone metabolism, to find evidence that hypoxia can improve bone metabolism, and to provide a new research direction for the treatment of complications in patients with CKD.

Research methods

We searched relevant articles published in multiple languages and fields, summarized important information, and drew our conclusions.

Research results

Anemia and bone metabolism interact. The hypoxic environment could affect osteoblast/osteoclast maturation and differentiation, enhance the paracrine effect of mesenchymal stem cells, and reduce the inhibitory effect of fibroblast growth factor 23 on osteocyte differentiation. Hypoxia potentially improves bone metabolism, but the optimal concentration and duration of hypoxia remain unclear and need further study.

Research conclusions

There is a bidirectional relationship between renal anemia and abnormal bone metabolism. The relationship has rarely been studied. Hypoxia may improve bone metabolism, but the concentration and duration of hypoxia remain unclear and need further study. To improve the quality of life of patients with CKD, future studies should address the effect of HIF on bone metabolism while treating anemia, and HIF may be a useful treatment for improving the prognosis of patients with CKD.

Research perspectives

In future studies, we can focus more on the exact degree of hypoxia concentration and duration required for improving bone metabolism.