Might hyperbaric oxygen therapy (HBOT) reduce renal injury in diabetic people with diabetes mellitus? From preclinical models to human metabolomics

Abstract

Diabetic kidney disease (DKD) is the leading cause of end-stage renal failure in the western world. Current treatment of diabetic kidney disease relies on nutritional management and drug therapies to achieve metabolic control. Here, we discuss the potential application of hyperbaric oxygen therapy (HBOT) for the treatment of diabetic kidney disease (DKD), a treatment which requires patients to breathe in 100% oxygen at elevated ambient pressures. HBOT has traditionally been used to diabetic foot ulcers (DFU) refractory to conventional medical treatments. Successful clinic responses seen in the DFU provide the underlying therapeutic rationale for testing HBOT in the setting of DKD. Both the DFU and DKD have microvascular endothelial disease as a common underlying pathologic feature. Supporting evidence for HBOT of DKD comes from previous animal studies and from our preliminary prospective clinical trial reported here. We report urinary metabolomic data obtained from patients undergoing HBOT for DFU, before and after exposure to 6 weeks of HBOT. The preliminary data support the concept that HBOT can reduce biomarkers of renal injury, oxidant stress, and mitochondrial dysfunction in patients receiving HBOT for DFU. Further studies are needed to confirm these initial findings and correlate them with simultaneous measures of renal function. HBOT is a safe and effective treatment for DFU and could also be for individuals with DKD.

Can hyperbaric oxygen safely serve as an anti-inflammatory treatment for COVID-19?

“…Indeed, HBO 2 has been shown to preserve mitochondrial activity [23] . Moreover, HBO 2 improved kidney function after infection [24] , protected organs from ischemia/reperfusion injury [25] , [26] , reduced UV skin damage [27] , and avoided kidney damage in diabetic patients [28] . Studies using an experimental animal model of sepsis that is characterized by an overwhelming inflammatory response showed a significant improvement in mortality after a single HBO 2 treatment (2.4 Atmospheres absolute (ATA), 60 min) very early after the initial insult.…”

Renal Effects of Hyperbaric Oxygen Therapy in Patients with Diabetes Mellitus: A Retrospective Study

“…On the other hand, a study of the effects of HBOT in normal New Zealand White rabbits found increased serum creatinine levels and histologic signs of proximal tubular damage in the treatment group [14]. e only study of the effects of HBOT on renal function in humans was a preliminary report published by Harrison et al of a study of HBOT on urine biomarkers in 17 volunteer patients with diabetes; however, this report did not include any clinical data on renal function and proteinuria [3].…”

“…The only study of the effects of HBOT on renal function in humans was a preliminary report published by Harrison et al of a study of HBOT on urine biomarkers in 17 volunteer patients with diabetes; however, this report did not include any clinical data on renal function and proteinuria [ 3 ].…”

“…HBOT is believed to exert some of its beneficial effects on wound healing by increasing reactive oxygen radical production and angiogenesis. ese same factors are implicated in the pathogenesis of microvascular complications of diabetes in the eye and in the kidney [3]. is suggests HBOT might be potentially harmful for patients with diabetes; however, animal studies show reduced proteinuria with HBOT treatments [4][5][6].…”

COVID-19, acute respiratory distress syndrome (ARDS), and hyperbaric oxygen therapy (HBOT): what is the link?

“…An additional advantage of HBOT is its capacity to reduce the inflammatory response (Buras et al 2006;Halbach et al 2019). Several studies have shown that HBOT improves kidney function after infection (Edremitlioglu et al 2005) and reduces kidney damage in diabetic patients (Harrison et al 2018). It has also been reported to protect from ischemia/reperfusion injury (Buras and Reenstra 2007;Yu et al 2005) and diminish UV skin damage (Fuller et al 2013).…”