Added sugars drive chronic kidney disease and its consequences: A comprehensive review

Abstract

The consumption of added sugars (e.g. sucrose [table sugar] and high-fructose corn syrup) over the last 200 years has increased exponentially and parallels the increased prevalence of chronic kidney disease (CKD). Data for animals and humans suggest that the consumption of added sugars leads to kidney damage and related metabolic derangements that increase cardiovascular risk. Importantly, the consumption of added sugars has been found to induce insulin resistance and increase uric acid in humans, both of which increase the conversion of glucose to fructose (i.e. fructogenesis) via the polyol pathway. The polyol pathway has recently been implicated in the contribution and progression of kidney damage, suggesting that even glucose can be toxic to the kidney via its endogenous transformation into fructose in the proximal tubule. Consuming added fructose has been shown to induce insulin resistance, which can lead to hyperglycaemia, oxidative stress, inflammation and the activation of the immune system, all of which can synergistically contribute to kidney damage. CKD guidelines should stress a reduction in the consumption of added sugars as a means to prevent and treat CKD as well as reduce CKD–related morbidity and mortality.