Cold atmospheric plasma for chronic kidney disease-related skin disorders

Background An estimated 80% of individuals with chronic kidney disease (CKD) experience concomitant skin disorders, yet experimental research that elucidates the pathological changes in CKD-affected skin is limited. Cold atmospheric plasma (CAP) has shown promise in regulating keratinocyte proliferation, skin barrier function and anti-inflammatory activity. We hypothesize that CAP will emerge as a promising therapeutic avenue for CKD-related skin diseases.Methods Male and female C57BL/6 mice were administered a 0.2% adenine diet to generate a CKD mouse model. Skin samples from dialysis patients were also collected. These models were used to investigate the pathological alterations in the renal glomeruli, tubules and epidermis. Subsequently, the potential impact of CAP on the stratum corneum, keratinocytes, skin hydration and inflammation in mice with CKD was examined.Results Renal biopsies revealed glomerular and tubular atrophy, epithelial degeneration and necrosis in uriniferous tubules and significant renal interstitial fibrosis. Skin biopsies from patients with CKD and mice showed stratum corneum thickening, epidermis atrophy, skin hydration dysfunction and excessive inflammation. CAP attenuated skin atrophy, hydration dysfunction and inflammation in mice with CKD, as evidenced by the activated level of YAP1/beta-catenin and Nrf-2/OH-1; enhanced expression of K5 and Ki67; increased levels of AQP3, collagen I and GLUT1; reduced infiltration of CD3+ T cells and diminished levels of IL-6 and TNF-alpha.Conclusions This study provides valuable insights into the pathological changes in skin associated with CKD in both patients and animal models. It also establishes that CAP has the potential to effectively mitigate skin atrophy, hydration dysfunction and inflammation, suggesting a novel therapeutic avenue for the treatment of CKD-related skin disorders. Graphical Abstract