Cardiorenal syndrome (CRS) is a multifactorial clinical condition characterized by the bidirectional deterioration of cardiac and renal function, driven by mechanisms such as renin–angiotensin–aldosterone system (RAAS) overactivation, systemic inflammation, oxidative stress, endothelial dysfunction, and fibrosis. The aim of this narrative review is to explore the key molecular pathways involved in CRS and to highlight emerging therapeutic approaches, with a special emphasis on nutritional interventions. We examined recent evidence on the contribution of mitochondrial dysfunction, uremic toxins, and immune activation to CRS progression and assessed the role of dietary and micronutrient factors. Results indicate that a high dietary intake of sodium, phosphorus additives, and processed foods is associated with volume overload, vascular damage, and inflammation, whereas deficiencies in potassium, magnesium, and vitamin D correlate with worse clinical outcomes. Anti-inflammatory and antioxidant bioactives, such as omega-3 PUFAs, curcumin, and anthocyanins from maqui, demonstrate potential to modulate key CRS mechanisms, including the nuclear factor kappa B (NF-κB) pathway and the NLRP3 inflammasome. Gene therapy approaches targeting endothelial nitric oxide synthase (eNOS) and transforming growth factor-beta (TGF-β) signaling are also discussed. An integrative approach combining pharmacological RAAS modulation with personalized medical nutrition therapy and anti-inflammatory nutrients may offer a promising strategy to prevent or delay CRS progression and improve patient outcomes.

Background/Objectives: Chronic kidney disease (CKD) is a progressive pathology, with high global prevalence, associated with inflammation and oxidative stress. Given the limited capacity of conventional treatments to reverse renal damage, complementary alternatives have emerged such as supplementation with anthocyanins from maqui (Aristotelia chilensis), known for their antioxidant and anti-inflammatory properties. This review analyzes the evidence for their impact on CKD progression. Methods: A narrative review of the experimental literature regarding maqui anthocyanins, their bioavailability, and their effects on oxidative stress, inflammation, and CKD to January 2025 was conducted. Articles without peer review or without a focus on Aristotelia chilensis were excluded, guaranteeing an updated compilation on its nephroprotective potential. Results: Anthocyanins have shown benefits in reducing oxidative stress, inflammation, and glycemia regulation. Preclinical studies suggest improvements in renal function as well as less fibrosis. Human trials indicate positive effects on metabolism, although evidence in CKD patients is limited. Bioavailability remains a challenge to optimizing efficacy. Conclusions: Maqui is a promising source of anthocyanins, with nephroprotective potential. However, robust clinical studies are required to determine its safety, optimal dose, and long-term impact in CKD. Its incorporation into evidence-based therapeutic strategies could offer an innovative approach in the management of this disease. More clinical studies are needed to validate the preclinical findings and optimize the therapeutic use of maqui in CKD.

Maqui (Aristotelia chilensis) is a berry native to southern Chile, recognized for its high content of phenolic compounds, particularly delphinidin-type anthocyanins, which confer strong antioxidant and anti-inflammatory properties and have generated growing interest as a functional food. Its scientific relevance has increased due to advances in understanding its biological mechanisms, including the Nrf2 signaling pathway, modulation of systemic inflammation, improvement in mitochondrial function, and potential applications in cardiometabolic, renal, and vascular health. Objective: The objective of this study is to analyze the available evidence on maqui in relation to its nutritional composition, bioactive profile, antioxidant and anti-inflammatory mechanisms, bioavailability, and emerging clinical applications in the prevention and/or treatment of chronic non-communicable diseases. Main findings: Maqui is rich in delphinidins, dietary fiber, and antioxidant micronutrients and modulates key oxidative stress and inflammatory pathways, including Nrf2-HO-1 and NF-κB. Preclinical and early clinical evidence supports its cardiometabolic and nephroprotective effects, with improvements in glycemic control, lipid metabolism, oxidative stress, and endothelial function. Conclusions: Maqui shows considerable potential as a Chilean functional food with antioxidant and anti-inflammatory effects relevant to human health. However, robust clinical trials and formulations with enhanced bioavailability are required to consolidate its therapeutic application.