Nitric oxide deficiency in chronic kidney disease

Am J Physiol Renal Physiol. 2008 Jan;294(1):F1-9. doi: 10.1152/ajprenal.00424.2007. Epub 2007 Oct 10.


The overall production of nitric oxide (NO) is decreased in chronic kidney disease (CKD) which contributes to cardiovascular events and further progression of kidney damage. There are many likely causes of NO deficiency in CKD and the areas surveyed in this review are: 1. Limitations on substrate (l-Arginine) availability, probably due to impaired renal l-Arginine biosynthesis, decreased transport of l-Arginine into endothelial cells and possible competition between NOS and competing metabolic pathways, such as arginase. 2. Increased circulating levels of endogenous NO synthase (NOS) inhibitors, in particular asymmetric dimethylarginine (ADMA). Increased methylation of proteins and their subsequent breakdown to release free ADMA may contribute but the major culprit is probably reduced ADMA catabolism by the enzymes dimethylarginine dimethylaminohydrolases. 3. Reduced renal cortex abundance of the neuronal NOS (nNOS)alpha protein correlates with injury while increasing nNOSbeta abundance may provide a compensatory, protective response. Interventions that can restore NO production by targeting these various pathways are likely to reduce the cardiovascular complications of CKD as well as slowing the rate of progression.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Arginine / analogs & derivatives
  • Arginine / metabolism
  • Chronic Disease
  • Humans
  • Kidney Diseases / metabolism*
  • Nitric Oxide / deficiency*
  • Nitric Oxide / metabolism
  • Nitric Oxide Synthase / metabolism


  • Nitric Oxide
  • N,N-dimethylarginine
  • Arginine
  • Nitric Oxide Synthase