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• W2006344371 abstract "It has been known for a long time that excessive consumption of alcohol has adverse effects, including adverse impact on kidneys and kidney disease. Recently, observational evidence has been provided that moderate alcohol consumption is associated with less cardiovascular and renal risk. These issues had been summarized and discussed at the recent congress of the European Society for Biomedical Research and Alcoholism in Vienna. It has been known for a long time that excessive consumption of alcohol has adverse effects, including adverse impact on kidneys and kidney disease. Recently, observational evidence has been provided that moderate alcohol consumption is associated with less cardiovascular and renal risk. These issues had been summarized and discussed at the recent congress of the European Society for Biomedical Research and Alcoholism in Vienna. On occasion of the recent congress of the European Society for Biomedical Research on Alcoholism (ESBRA) in Vienna, 4–7 September 2011, one entire session had been devoted to the relationship between alcohol and the kidney. It was the goal of this session to provide an evenhanded analysis of the impact of alcohol consumption on the evolution of chronic kidney function and disease. The interest in the issue of alcohol and its effect on the kidney was aroused by the fact that—after several preceding negative analyses1.Vupputuri S. Sandler D.P. Lifestyle risk factors and chronic kidney disease.Ann Epidemiol. 2003; 13: 712-720Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar,2.Stengel B. Tarver-Carr M.E. Powe N.R. et al.Lifestyle factors, obesity and the risk of chronic kidney disease.Epidemiology. 2003; 14: 479-487Crossref PubMed Scopus (274) Google Scholar—a number of stringent prospective observational studies had recently documented that moderate alcohol consumption has a beneficial effect both on the decline in renal function with age and the evolution of primary kidney disease.3.White S.L. Polkinghorne K.R. Cass A. et al.Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study.Nephrol Dial Transplant. 2009; 24: 2464-2472Crossref PubMed Scopus (107) Google Scholar, 4.Schaeffner E.S. Kurth T. de Jong P.E. et al.Alcohol consumption and the risk of renal dysfunction in apparently healthy men.Arch Intern Med. 2005; 165: 1048-1053Crossref PubMed Scopus (84) Google Scholar, 5.Kaartinen K. Niemela O. Syrjanen J. et al.Alcohol consumption and kidney function in IgA glomerulonephritis.Nephron Clin Pract. 2009; 112: c86-c93Crossref PubMed Scopus (10) Google Scholar, 6.Reynolds K. Gu D. Chen J. et al.Alcohol consumption and the risk of end-stage renal disease among Chinese men.Kidney Int. 2008; 73: 870-876Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar The fact that one major session of the congress was devoted to the kidney indicates that these novel findings had a resonance even outside of nephrology. This was also reflected by an animated and constructive discussion. The documentation that moderate alcohol consumption retards progression of CKD is of interest because currently available interventions, e.g., RAS blockade, mineralocorticoid receptor blockade, endothelin receptor blockade, antioxidant anti-inflammation modulation, although undoubtedly reducing progression, fail to completely stop progression of CKD so that any additional additive measure is welcome. Since the nineteenth century, it has been known that alcoholism is associated with a higher risk of glomerulonephritis as reported by Frerichs7.Frerichs F.D. Die Bright'sche Nierenerkrankung und deren Behandlung. Verlag Friedrich Vieweg und Sohn, Braunschweig1833Google Scholar,8.Ritz E. Koleganova N. Heidland A. Renal research in 19th century Germany.Am J Kidney Dis. 2010; 55: 1121-1129Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar and many others. Recent reports also document that even today alcoholism remains a risk factor for post-infectious glomerulonephritis,9.Keller C.K. Andrassy K. Waldherr R. et al.Postinfectious glomerulonephritis--is there a link to alcoholism?.Q J Med. 1994; 87: 97-102PubMed Google Scholar,10.Nasr S.H. Markowitz G.S. Stokes M.B. et al.Acute postinfectious glomerulonephritis in the modern era: experience with 86 adults and review of the literature.Medicine (Baltimore). 2008; 87: 21-32Crossref PubMed Scopus (141) Google Scholar acute kidney injury,11.Bagshaw S.M. Laupland K.B. Doig C.J. et al.Prognosis for long-term survival and renal recovery in critically ill patients with severe acute renal failure: a population-based study.Crit Care. 2005; 9: R700-R709Crossref PubMed Google Scholar and kidney graft failure,12.Gueye A.S. Chelamcharla M. Baird B.C. et al.The association between recipient alcohol dependency and long-term graft and recipient survival.Nephrol Dial Transplant. 2007; 22: 891-898Crossref PubMed Scopus (34) Google Scholar and the only positive aspect was that alcohol consumption was associated with less renal cell carcinoma.13.Pelucchi C. Galeone C. Montella M. et al.Alcohol consumption and renal cell cancer risk in two Italian case-control studies.Ann Oncol. 2008; 19: 1003-1008Crossref PubMed Scopus (20) Google Scholar In the past two decades the beneficial effect of moderate consumption of alcohol on mortality14.Thun M.J. Peto R. Lopez A.D. et al.Alcohol consumption and mortality among middle-aged and elderly US adults.N Engl J Med. 1997; 337: 1705-1714Crossref PubMed Scopus (1085) Google Scholar has been well documented, including specifically the reduction of cardiovascular mortality, e.g., in the health professional follow-up study,15.Rimm E.B. Stampfer M.J. Wine, beer, and spirits: are they really horses of a different color?.Circulation. 2002; 105: 2806-2807Crossref PubMed Scopus (71) Google Scholar as well as the beneficial effects on the outcome of myocardial infarction16.Mukamal K.J. Maclure M. Muller J.E. et al.Prior alcohol consumption and mortality following acute myocardial infarction.JAMA. 2001; 285: 1965-1970Crossref PubMed Scopus (147) Google Scholar or heart failure.17.Bryson C.L. Mukamal K.J. Mittleman M.A. et al.The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study.J Am Coll Cardiol. 2006; 48: 305-311Abstract Full Text Full Text PDF PubMed Scopus (104) Google Scholar A beneficial effect on non-cardiovascular outcomes such as cognitive impairment18.Stampfer M.J. Kang J.H. Chen J. et al.Effects of moderate alcohol consumption on cognitive function in women.N Engl J Med. 2005; 352: 245-253Crossref PubMed Scopus (309) Google Scholar has been documented in observational studies as well. Information on the effect of alcohol on renal disease, however, had almost been absent for a considerable time. The beneficial effect of alcohol is clearly dose dependent and differs between men and women; the latter have lower hepatic alcohol dehydrogenase activity, but a beneficial effect of alcohol is demonstrable even in women up to an intake of ∼25g alcohol per day compared with ∼45g alcohol per day in men.19.Kloner R.A. Rezkalla S.H. To drink or not to drink? That is the question.Circulation. 2007; 116: 1306-1317Crossref PubMed Scopus (254) Google Scholar However, it is interesting to note that—with the interesting exception of Type 2 diabetes—the CV benefit is demonstrable only in those women over the age of 50 years.20.Fuchs C.S. Stampfer M.J. Colditz G.A. et al.Alcohol consumption and mortality among women.N Engl J Med. 1995; 332: 1245-1250Crossref PubMed Scopus (591) Google Scholar There has been a long-standing discussion whether all alcohol is created equal or whether wine, specifically red wine, differs from other types of alcohol. It appears that red wine provides additional coronary protection and that in general wine provides more cardiovascular protection than beer.21.Opie L.H. Lecour S. The red wine hypothesis: from concepts to protective signalling molecules.Eur Heart J. 2007; 28: 1683-1693Crossref PubMed Scopus (262) Google Scholar Given the fact that diabetic nephropathy has become the single most common cause of renal failure, it is of considerable interest that alcohol consumption decreases the risk of developing Type 2 diabetes; e.g., in the nurses' health study, daily alcohol consumption of 5.1–10g per day reduced the risk of new-onset Type 2 diabetes significantly (relative risk 0.56; 0.48–0.65).22.Hu F.B. Manson J.E. Stampfer M.J. et al.Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.N Engl J Med. 2001; 345: 790-797Crossref PubMed Scopus (2172) Google Scholar In type 1 diabetic individuals as well, the EURODIAB prospective complications study23.Beulens J.W. Kruidhof J.S. Grobbee D.E. et al.Alcohol consumption and risk of microvascular complications in type 1 diabetes patients: the EURODIAB Prospective Complications Study.Diabetologia. 2008; 51: 1631-1638Crossref PubMed Scopus (54) Google Scholar showed that daily consumption of 30–70g alcohol per week reduced the odds ratio (OR) of macroalbuminuria to 0.36. Although some early epidemiological studies on alcohol and progression of nondiabetic renal disease failed to provide documentation of a benefit in CKD,1.Vupputuri S. Sandler D.P. Lifestyle risk factors and chronic kidney disease.Ann Epidemiol. 2003; 13: 712-720Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar,2.Stengel B. Tarver-Carr M.E. Powe N.R. et al.Lifestyle factors, obesity and the risk of chronic kidney disease.Epidemiology. 2003; 14: 479-487Crossref PubMed Scopus (274) Google Scholar more recent large and well-designed studies document a beneficial effect of moderate alcohol consumption on loss of renal function not only in individuals with kidney disease but also in individuals without primary kidney disease, particularly elderly individuals. In a prospective study in 11,023 healthy men with 14 years of follow-up, Schaeffner4.Schaeffner E.S. Kurth T. de Jong P.E. et al.Alcohol consumption and the risk of renal dysfunction in apparently healthy men.Arch Intern Med. 2005; 165: 1048-1053Crossref PubMed Scopus (84) Google Scholar found that men who consumed at least seven drinks weekly had an OR of 0.71 to develop new onset of renal dysfunction, defined as serum creatinine ≥1.5mg/dl, compared with men who consumed ≤1 drink per week. A study on individuals with no primary kidney disease compared the impact of self-reported consumption of <30g alcohol per day with >30g alcohol per day on the development of albuminuria and estimated glomular filtration rate (eGFR) <60ml/min; the ORs for new onset of albuminuria was 1.59 and for eGFR <60ml/min 0.59.3.White S.L. Polkinghorne K.R. Cass A. et al.Alcohol consumption and 5-year onset of chronic kidney disease: the AusDiab study.Nephrol Dial Transplant. 2009; 24: 2464-2472Crossref PubMed Scopus (107) Google Scholar The discrepancy between the behavior of albuminuria and eGFR remains unexplained. Recent studies show that moderate alcohol consumption attenuates progression and loss of GFR in patients with primary kidney disease as well. A Finnish study5.Kaartinen K. Niemela O. Syrjanen J. et al.Alcohol consumption and kidney function in IgA glomerulonephritis.Nephron Clin Pract. 2009; 112: c86-c93Crossref PubMed Scopus (10) Google Scholar examined 158 individuals with IgA glomerulonephritis: in the cross-sectional arm (158 patients), proteinuria was lower in light and moderate drinkers, and their creatinine clearance was higher than in abstainers and heavy drinkers; in the longitudinal arm, the OR was 0.4 in light drinkers, 0.1 in moderate drinkers, but increased in heavy drinkers (2.3) compared with abstainers (OR 1.0) displaying a J-shaped relationship. The authors suggested that a daily alcohol intake of 11–27g alcohol was optimal with respect to renal function in women and 11–40g alcohol was optimal in men. The strongest association for a beneficial effect of alcohol on progression of CKD to ESRD was provided by Reynolds.6.Reynolds K. Gu D. Chen J. et al.Alcohol consumption and the risk of end-stage renal disease among Chinese men.Kidney Int. 2008; 73: 870-876Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar During 9 years of follow-up, the cumulative incidence of ‘onset of ESRD’ was 35.7 per 100,000 person years in abstainers; it was 21.1 in individuals who consumed <3drinks per day and 17.1 in individuals who consumed >3drinks per day (OR 0.45). Such beneficial effect is remarkable in view of the well-known fact that high alcohol consumption is associated with higher blood pressure values. However, this cannot necessarily be extrapolated to moderate alcohol use. A study by Renaud24.Renaud S.C. Guéguen R. Conard P. et al.Moderate wine drinkers have lower hypertension-related mortality: a prospective cohort study in French men.Am J Clin Nutr. 2004; 80: 621-625PubMed Google Scholar recently showed that at least moderate wine drinkers, not necessarily beer drinkers, had lower blood pressure values and lower all-cause mortality. Given the high cardiovascular risk of CKD patients, it is further interesting to note that in the Cardiovascular Health Study alcohol use was the only characteristic that was associated with a lower cardiovascular risk in CKD patients.25.Shlipak M.G. Fried L.F. Cushman M. et al.Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors.JAMA. 2005; 293: 1737-1745Crossref PubMed Scopus (585) Google Scholar In recipients of a renal transplant, less de novo diabetes and mortality was noted in individuals with moderate alcohol consumption.26.Zelle D.M. Agarwal P.K. Ramirez J.L. et al.Alcohol consumption, new onset of diabetes after transplantation, and all-cause mortality in renal transplant recipients.Transplantation. 2011; 92: 203-209Crossref PubMed Scopus (21) Google Scholar At least in animal experiments, polyphenols and quercetin in wine reduced cyclosporine nephrotoxicity by antagonizing oxidative stress–dependent renal damage.27.Satyanarayana P.S. Singh D. Chopra K. Quercetin, a bioflavonoid, protects against oxidative stress-related renal dysfunction by cyclosporine in rats.Methods Find Exp Clin Pharmacol. 2001; 23: 175-181Crossref PubMed Scopus (80) Google Scholar It has been argued that alcohol consumption is associated with less hyalinization of arterioles in renal tissue.28.Burchfiel C.M. Tracy R.E. Chyou P.H. et al.Cardiovascular risk factors and hyalinization of renal arterioles at autopsy. The Honolulu Heart Program.Arterioscler Thromb Vasc Biol. 1997; 17: 760-768Crossref PubMed Scopus (73) Google Scholar At least in animal studies, evidence was provided that polyphenols function as ROS scavengers and metal chelators; furthermore, ethanol increases the activity of antioxidant enzymes29.Rodrigo R. Miranda A. Vergara L. Modulation of endogenous antioxidant system by wine polyphenols in human disease.Clin Chim Acta. 2011; 412: 410-424Crossref PubMed Scopus (220) Google Scholar as shown in the model of glycerol injection rhabdomyolysis with acute renal failure; moreover, less lipid peroxidation (malondialdeyde) and less protein oxidation (carbonyl content) had been shown. A further mechanism is the effect of resveratrol on sirtuin, which deacetylates and inactivates p53.21.Opie L.H. Lecour S. The red wine hypothesis: from concepts to protective signalling molecules.Eur Heart J. 2007; 28: 1683-1693Crossref PubMed Scopus (262) Google Scholar Human nature being what it is, it will be a challenge to always find the right balance between health benefit from moderate alcohol consumption and alcohol-induced renal pathology from addiction. In view of the Janus-faced role of alcohol—beneficial at moderate and deleterious at high consumption—a balanced approach in the management of patients with CKD and of elderly individuals with progressive loss of renal function is appropriate." @default.
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• W2006344371 title "Alcohol and kidney damage: a Janus-faced relationship" @default.
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