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Moorthi RN, Moe SM, O'Connell T, Dickinson S, Kalim S, Thadhani R, Clish CB, Shafi T, Rhee EP, Avin KG. Plasma metabolites and physical function in patients undergoing hemodialysis. Sci Rep 2024; 14:8427. [PMID: 38600145 PMCID: PMC11006868 DOI: 10.1038/s41598-024-58522-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024] Open
Abstract
Impaired physical function contributes to falls, fractures, and mortality among patients undergoing dialysis. Using a metabolomic approach, we identified metabolite alterations and effect size-based composite scores for constructs of impaired gait speed and grip strength. 108 participants incident to dialysis had targeted plasma metabolomics via liquid chromatography-mass spectrometry and physical function assessed (i.e., 4 m walk, handgrip strength). Physical function measures were categorized as above/ below median, with grip utilizing sex-based medians. To develop composite scores, metabolites were identified via Wilcoxon uncorrected p < 0.05 and effect size > 0.40. Receiver operating characteristic analyses tested whether scores differentiated between above/below function groups. Participants were 54% male, 77% Black and 53 ± 14 y with dialysis vintage of 101 ± 50 days. Median (IQR) grip strength was 35.5 (11.1) kg (males) and 20 (8.4) kg (females); median gait speed was 0.82 (0.34) m/s. Of 246 measured metabolites, composite scores were composed of 22 and 12 metabolites for grip strength and gait speed, respectively. Area under the curve for metabolite composite was 0.88 (gait) and 0.911 (grip). Composite scores of physical function performed better than clinical parameters alone in patients on dialysis. These results provide potential pathways for interventions and needed validation in an independent cohort.
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Affiliation(s)
| | - Sharon M Moe
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Sahir Kalim
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Ravi Thadhani
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Tariq Shafi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MI, 39216, USA
| | - Eugene P Rhee
- Department of Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Keith G Avin
- Indiana University School of Medicine, Indianapolis, IN, USA.
- School of Health and Human Sciences, IUPUI, Indianapolis, IN, USA.
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Caggiano G, Stasi A, Franzin R, Fiorentino M, Cimmarusti MT, Deleonardis A, Palieri R, Pontrelli P, Gesualdo L. Fecal Microbiota Transplantation in Reducing Uremic Toxins Accumulation in Kidney Disease: Current Understanding and Future Perspectives. Toxins (Basel) 2023; 15:toxins15020115. [PMID: 36828429 PMCID: PMC9965504 DOI: 10.3390/toxins15020115] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
During the past decades, the gut microbiome emerged as a key player in kidney disease. Dysbiosis-related uremic toxins together with pro-inflammatory mediators are the main factors in a deteriorating kidney function. The toxicity of uremic compounds has been well-documented in a plethora of pathophysiological mechanisms in kidney disease, such as cardiovascular injury (CVI), metabolic dysfunction, and inflammation. Accumulating data on the detrimental effect of uremic solutes in kidney disease supported the development of many strategies to restore eubiosis. Fecal microbiota transplantation (FMT) spread as an encouraging treatment for different dysbiosis-associated disorders. In this scenario, flourishing studies indicate that fecal transplantation could represent a novel treatment to reduce the uremic toxins accumulation. Here, we present the state-of-the-art concerning the application of FMT on kidney disease to restore eubiosis and reverse the retention of uremic toxins.
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Prasad GVR, Nash MM, Yuan W, Beriault D, Yazdanpanah M, Connelly PW. Plasma Branched-Chain Amino Acid Concentrations and Glucose Homeostasis in Kidney Transplant Recipients and Candidates. Can J Kidney Health Dis 2023; 10:20543581231168085. [PMID: 37101847 PMCID: PMC10123875 DOI: 10.1177/20543581231168085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/28/2023] [Indexed: 04/28/2023] Open
Abstract
Background Post-transplant diabetes mellitus (PTDM) encompasses new-onset and previously unrecognized type 2 diabetes. Kidney failure masks type 2 diabetes. Branched-chain amino acids (BCAA) are closely associated with glucose metabolism. Therefore, understanding BCAA metabolism both in kidney failure and after kidney transplantation may inform PTDM mechanisms. Objective To understand the impact of present or absent kidney function on plasma BCAA concentrations. Design Cross-sectional study of kidney transplant recipients and kidney transplant candidates. Setting Large kidney transplant center in Toronto, Canada. Measurements We measured plasma BCAA and aromatic amino acid (AAA) concentrations in 45 pre-kidney transplant candidates (15 with type 2 diabetes, 30 without type 2 diabetes) and 45 post-kidney transplant recipients (15 PTDM, 30 non-PTDM), along with insulin resistance and sensitivity by 75 g oral glucose loading for those in each group without type 2 diabetes. Methods Plasma AA concentrations were analyzed using MassChrom AA Analysis and compared between groups. The insulin sensitivity for oral glucose tolerance tests or Matsuda index (a measure of whole-body insulin resistance), Homeostatic Model Assessment for Insulin Resistance (a measure of hepatic insulin resistance), and Insulin Secretion-Sensitivity Index-2 (ISSI-2, a measure of pancreatic β-cell response) was calculated from fasting insulin and glucose concentrations, and compared with BCAA concentrations. Results Each BCAA concentration was higher in post-transplant subjects than pre-transplant subjects (P < .001 for leucine, isoleucine, valine). In post-transplant subjects, each BCAA concentration was higher in PTDM versus non-PTDM (odds ratio for PTDM 3-4 per 1 SD increase in BCAA concentration, P < .001 for each). Tyrosine concentrations were also higher in post-transplant subjects than pre-transplant subjects, but tyrosine did not differ by PTDM status. By contrast, neither BCAA nor AAA concentrations were different in pre-transplant subjects with or without type 2 diabetes. Whole-body insulin resistance, hepatic insulin resistance, and pancreatic β-cell response did not differ between nondiabetic post-transplant and pre-transplant subjects. Branched-chain amino acid concentrations correlated with the Matsuda index and Homeostatic Model Assessment for Insulin Resistance (P < .05 for each) only in nondiabetic post-transplant subjects-not in nondiabetic pre-transplant subjects. Branched-chain amino acid concentrations did not correlate with ISSI-2 in either pre-transplant or post-transplant subjects. Limitations The sample size was small, and subjects were not studied prospectively for the development of type 2 diabetes. Conclusions Plasma BCAA concentrations are higher post-transplant in type 2 diabetic states, but do not differ by diabetes status in the presence of kidney failure. The association of BCAA with measures of hepatic insulin resistance among nondiabetic post-transplant patients is consistent with impaired BCAA metabolism as a characteristic of kidney transplantation.
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Affiliation(s)
- G. V. Ramesh Prasad
- Department of Medicine, University of Toronto, ON, Canada
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
- G. V. Ramesh Prasad, Kidney Transplant Program, St. Michael’s Hospital, 61 Queen Street East, 9th Floor, Toronto, ON M5C 2T2, Canada.
| | - M. M. Nash
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
| | - W. Yuan
- Kidney Transplant Program, St. Michael’s Hospital, Toronto, ON, Canada
| | - D. Beriault
- Department of Laboratory Medicine, University of Toronto, ON, Canada
| | - M. Yazdanpanah
- Department of Laboratory Medicine, University of Toronto, ON, Canada
| | - P. W. Connelly
- Department of Medicine, University of Toronto, ON, Canada
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Castro A, Duft RG, de Oliveira-Nunes SG, de Andrade ALL, Cavaglieri CR, Chacon-Mikahil MPT. Association Between Changes in Serum and Skeletal Muscle Metabolomics Profile With Maximum Power Output Gains in Response to Different Aerobic Training Programs: The Times Study. Front Physiol 2021; 12:756618. [PMID: 34744794 PMCID: PMC8563999 DOI: 10.3389/fphys.2021.756618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/23/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose: High heterogeneity of the response of cardiorespiratory fitness (CRF) to standardized exercise doses has been reported in different training programs, but the associated mechanisms are not widely known. This study investigated whether changes in the metabolic profile and pathways in blood serum and the skeletal muscle are associated with the inter-individual variability of CRF responses to 8-wk of continuous endurance training (ET) or high-intensity interval training (HIIT). Methods: Eighty men, young and sedentary, were randomized into three groups, of which 70 completed 8 wk of intervention (> 90% of sessions): ET, HIIT, or control. Blood and vastus lateralis muscle tissue samples, as well as the measurement of CRF [maximal power output (MPO)] were obtained before and after the intervention. Blood serum and skeletal muscle samples were analyzed by 600 MHz 1H-NMR spectroscopy (metabolomics). Associations between the pretraining to post-training changes in the metabolic profile and MPO gains were explored via three analytical approaches: (1) correlation between pretraining to post-training changes in metabolites' concentration levels and MPO gains; (2) significant differences between low and high MPO responders; and (3) metabolite contribution to significantly altered pathways related to MPO gains. After, metabolites within these three levels of evidence were analyzed by multiple stepwise linear regression. The significance level was set at 1%. Results: The metabolomics profile panel yielded 43 serum and 70 muscle metabolites. From the metabolites within the three levels of evidence (15 serum and 4 muscle metabolites for ET; 5 serum and 1 muscle metabolites for HIIT), the variance in MPO gains was explained: 77.4% by the intervention effects, 6.9, 2.3, 3.2, and 2.2% by changes in skeletal muscle pyruvate and valine, serum glutamine and creatine phosphate, respectively, in ET; and 80.9% by the intervention effects; 7.2, 2.2, and 1.2% by changes in skeletal muscle glycolate, serum creatine and creatine phosphate, respectively, in HIIT. The most changed and impacted pathways by these metabolites were: arginine and proline metabolism, glycine, serine and threonine metabolism, and glyoxylate and dicarboxylate metabolism for both ET and HIIT programs; and additional alanine, aspartate and glutamate metabolism, arginine biosynthesis, glycolysis/gluconeogenesis, and pyruvate metabolism for ET. Conclusion: These results suggest that regulating the metabolism of amino acids and carbohydrates may be a potential mechanism for understanding the inter-individual variability of CRF in responses to ET and HIIT programs.
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Affiliation(s)
- Alex Castro
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas (UNICAMP), São Paulo, Brazil.,Nuclear Magnetic Resonance Laboratory, Department of Chemistry, Federal University of São Carlos (UFSCar), São Paulo, Brazil
| | - Renata G Duft
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas (UNICAMP), São Paulo, Brazil
| | | | | | - Claudia R Cavaglieri
- Laboratory of Exercise Physiology, School of Physical Education, University of Campinas (UNICAMP), São Paulo, Brazil
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Wee HN, Liu JJ, Ching J, Kovalik JP, Lim SC. The Kynurenine Pathway in Acute Kidney Injury and Chronic Kidney Disease. Am J Nephrol 2021; 52:771-787. [PMID: 34753140 PMCID: PMC8743908 DOI: 10.1159/000519811] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The kynurenine pathway (KP) is the major catabolic pathway for tryptophan degradation. The KP plays an important role as the sole de novo nicotinamide adenine dinucleotide (NAD+) biosynthetic pathway in normal human physiology and functions as a counter-regulatory mechanism to mitigate immune responses during inflammation. Although the KP has been implicated in a variety of disorders including Huntington's disease, seizures, cardiovascular disease, and osteoporosis, its role in renal diseases is seldom discussed. SUMMARY This review summarizes the roles of the KP and its metabolites in acute kidney injury (AKI) and chronic kidney disease (CKD) based on current literature evidence. Metabolomics studies demonstrated that the KP metabolites were significantly altered in patients and animal models with AKI or CKD. The diagnostic and prognostic values of the KP metabolites in AKI and CKD were highlighted in cross-sectional and longitudinal human observational studies. The biological impact of the KP on the pathophysiology of AKI and CKD has been studied in experimental models of different etiologies. In particular, the activation of the KP was found to confer protection in animal models of glomerulonephritis, and its immunomodulatory mechanism may involve the regulation of T cell subsets such as Th17 and regulatory T cells. Manipulation of the KP to increase NAD+ production or diversion toward specific KP metabolites was also found to be beneficial in animal models of AKI. Key Messages: KP metabolites are reported to be dysregulated in human observational and animal experimental studies of AKI and CKD. In AKI, the magnitude and direction of changes in the KP depend on the etiology of the damage. In CKD, KP metabolites are altered with the onset and progression of CKD all the way to advanced stages of the disease, including uremia and its related vascular complications. The activation of the KP and diversion to specific sub-branches are currently being explored as therapeutic strategies in these diseases, especially with regards to the immunomodulatory effects of certain KP metabolites. Further elucidation of the KP may hold promise for the development of biomarkers and targeted therapies for these kidney diseases.
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Affiliation(s)
| | - Jian-Jun Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Jianhong Ching
- Duke-NUS Medical School, Singapore, Singapore
- KK Research Centre, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Su Chi Lim
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Diabetes Centre, Admiralty Medical Centre, Singapore, Singapore
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Denburg MR, Xu Y, Abraham AG, Coresh J, Chen J, Grams ME, Feldman HI, Kimmel PL, Rebholz CM, Rhee EP, Vasan RS, Warady BA, Furth SL. Metabolite Biomarkers of CKD Progression in Children. Clin J Am Soc Nephrol 2021; 16:1178-1189. [PMID: 34362785 PMCID: PMC8455058 DOI: 10.2215/cjn.00220121] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Metabolomics facilitates the discovery of biomarkers and potential therapeutic targets for CKD progression. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We evaluated an untargeted metabolomics quantification of stored plasma samples from 645 Chronic Kidney Disease in Children (CKiD) participants. Metabolites were standardized and logarithmically transformed. Cox proportional hazards regression examined the association between 825 nondrug metabolites and progression to the composite outcome of KRT or 50% reduction of eGFR, adjusting for age, sex, race, body mass index, hypertension, glomerular versus nonglomerular diagnosis, proteinuria, and baseline eGFR. Stratified analyses were performed within subgroups of glomerular/nonglomerular diagnosis and baseline eGFR. RESULTS Baseline characteristics were 391 (61%) male; median age 12 years; median eGFR 54 ml/min per 1.73 m2; 448 (69%) nonglomerular diagnosis. Over a median follow-up of 4.8 years, 209 (32%) participants developed the composite outcome. Unique association signals were identified in subgroups of baseline eGFR. Among participants with baseline eGFR ≥60 ml/min per 1.73 m2, two-fold higher levels of seven metabolites were significantly associated with higher hazards of KRT/halving of eGFR events: three involved in purine and pyrimidine metabolism (N6-carbamoylthreonyladenosine, hazard ratio, 16; 95% confidence interval, 4 to 60; 5,6-dihydrouridine, hazard ratio, 17; 95% confidence interval, 5 to 55; pseudouridine, hazard ratio, 39; 95% confidence interval, 8 to 200); two amino acids, C-glycosyltryptophan, hazard ratio, 24; 95% confidence interval 6 to 95 and lanthionine, hazard ratio, 3; 95% confidence interval, 2 to 5; the tricarboxylic acid cycle intermediate 2-methylcitrate/homocitrate, hazard ratio, 4; 95% confidence interval, 2 to 7; and gulonate, hazard ratio, 10; 95% confidence interval, 3 to 29. Among those with baseline eGFR <60 ml/min per 1.73 m2, a higher level of tetrahydrocortisol sulfate was associated with lower risk of progression (hazard ratio, 0.8; 95% confidence interval, 0.7 to 0.9). CONCLUSIONS Untargeted plasma metabolomic profiling facilitated discovery of novel metabolite associations with CKD progression in children that were independent of established clinical predictors and highlight the role of select biologic pathways.
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Affiliation(s)
- Michelle R. Denburg
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yunwen Xu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison G. Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Morgan E. Grams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Harold I. Feldman
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul L. Kimmel
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eugene P. Rhee
- Department of Medicine, Massachusetts General Hospital, Department of Medicine, Harvard University, Boston, Massachusetts
| | - Ramachandran S. Vasan
- Department of Medicine, Boston University School of Medicine, Boston University School of Public Health, and Boston University Center for Computing and Data Science, Boston, Massachusetts
| | - Bradley A. Warady
- Children’s Mercy Kansas City, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Susan L. Furth
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Zhu S, Zhang F, Shen AW, Sun B, Xia TY, Chen WS, Tao X, Yu SQ. Metabolomics Evaluation of Patients With Stage 5 Chronic Kidney Disease Before Dialysis, Maintenance Hemodialysis, and Peritoneal Dialysis. Front Physiol 2021; 11:630646. [PMID: 33551851 PMCID: PMC7855177 DOI: 10.3389/fphys.2020.630646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Current treatment options for patients with stage 5 chronic kidney disease before dialysis (predialysis CKD-5) are determined by individual circumstances, economic factors, and the doctor’s advice. This study aimed to explore the plasma metabolic traits of patients with predialysis CKD-5 compared with maintenance hemodialysis (HD) and peritoneal dialysis (PD) patients, to learn more about the impact of the dialysis process on the blood environment. Methods Our study enrolled 31 predialysis CKD-5 patients, 31 HD patients, and 30 PD patients. Metabolite profiling was performed using a targeted metabolomics platform by applying an ultra-high-performance liquid chromatography-tandem mass spectrometry method, and the subsequent comparisons among all three groups were made to explore metabolic alterations. Results Cysteine metabolism was significantly altered between predialysis CKD-5 patients and both groups of dialysis patients. A disturbance in purine metabolism was the most extensively changed pathway identified between the HD and PD groups. A total of 20 discriminating metabolites with large fluctuations in plasma concentrations were screened from the group comparisons, including 2-keto-D-gluconic acid, kynurenic acid, s-adenosylhomocysteine, L-glutamine, adenosine, and nicotinamide. Conclusion Our study provided a comprehensive metabolomics evaluation among predialysis CKD-5, HD, and PD patients, which described the disturbance of metabolic pathways, discriminating metabolites and their possible biological significances. The identification of specific metabolites related to dialysis therapy might provide insights for the management of advanced CKD stages and inform shared decision-making.
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Affiliation(s)
- Sang Zhu
- Department of Pharmacy, The Affiliated Wuxi Children's Hospital of Nanjing Medical University, Wuxi, China
| | - Feng Zhang
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Ai-Wen Shen
- Department of Nephrology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Bo Sun
- Department of Nephrology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tian-Yi Xia
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wan-Sheng Chen
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xia Tao
- Department of Pharmacy, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Sheng-Qiang Yu
- Department of Nephrology, Changzheng Hospital, Naval Medical University, Shanghai, China
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Rydzewska-Rosołowska A, Sroka N, Kakareko K, Rosołowski M, Zbroch E, Hryszko T. The Links between Microbiome and Uremic Toxins in Acute Kidney Injury: Beyond Gut Feeling-A Systematic Review. Toxins (Basel) 2020; 12:E788. [PMID: 33322362 PMCID: PMC7764335 DOI: 10.3390/toxins12120788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 12/16/2022] Open
Abstract
The last years have brought an abundance of data on the existence of a gut-kidney axis and the importance of microbiome in kidney injury. Data on kidney-gut crosstalk suggest the possibility that microbiota alter renal inflammation; we therefore aimed to answer questions about the role of microbiome and gut-derived toxins in acute kidney injury. PubMed and Cochrane Library were searched from inception to October 10, 2020 for relevant studies with an additional search performed on ClinicalTrials.gov. We identified 33 eligible articles and one ongoing trial (21 original studies and 12 reviews/commentaries), which were included in this systematic review. Experimental studies prove the existence of a kidney-gut axis, focusing on the role of gut-derived uremic toxins and providing concepts that modification of the microbiota composition may result in better AKI outcomes. Small interventional studies in animal models and in humans show promising results, therefore, microbiome-targeted therapy for AKI treatment might be a promising possibility.
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Affiliation(s)
- Alicja Rydzewska-Rosołowska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; (N.S.); (K.K.); (E.Z.); (T.H.)
| | - Natalia Sroka
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; (N.S.); (K.K.); (E.Z.); (T.H.)
| | - Katarzyna Kakareko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; (N.S.); (K.K.); (E.Z.); (T.H.)
| | - Mariusz Rosołowski
- Department of Gastroenterology and Internal Medicine, Medical University of Białystok, 15-276 Białystok, Poland;
| | - Edyta Zbroch
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; (N.S.); (K.K.); (E.Z.); (T.H.)
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Białystok, 15-276 Białystok, Poland; (N.S.); (K.K.); (E.Z.); (T.H.)
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Louca P, Mompeo O, Leeming ER, Berry SE, Mangino M, Spector TD, Padmanabhan S, Menni C. Dietary Influence on Systolic and Diastolic Blood Pressure in the TwinsUK Cohort. Nutrients 2020; 12:E2130. [PMID: 32708992 PMCID: PMC7400881 DOI: 10.3390/nu12072130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023] Open
Abstract
Nutrition plays a key role in blood pressure (BP) regulation. Here, we examine associations between nutrient intakes and BP in a large predominantly female population-based cohort. We assessed the correlation between 45 nutrients (from food frequency questionnaires) and systolic BP/diastolic BP (SBP/DBP) in 3889 individuals from TwinsUK not on hypertensive treatments and replicated in an independent subset of monozygotic twins discordant for nutrient intake (17-242 pairs). Results from both analyses were meta-analysed. For significant nutrients, we calculated heritability using structural equation modelling. We identified and replicated 15 nutrients associated with SBP, 9 also being associated with DBP, adjusting for covariates and multiple testing. 14 of those had a heritable component (h2: 27.1-57.6%). Strong associations with SBP were observed for riboflavin (Beta(SE) = -1.49(0.38), P = 1.00 × 10-4) and tryptophan (-0.31(0.01), P = 5 × 10-4), while with DBP for alcohol (0.05(0.07), P = 1.00 × 10-4) and lactose (-0.05(0.0), P = 1.3 × 10-3). Two multivariable nutrient scores, combining independently SBP/DBP-associated nutrients, explained 22% of the variance in SBP and 13.6% of the variance in DBP. Moreover, bivariate heritability analysis suggested that nutrients and BP share some genetic influences. We confirm current understanding and extend the panel of dietary nutrients implicated in BP regulation underscoring the value of nutrient focused dietary research in preventing and managing hypertension.
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Affiliation(s)
- Panayiotis Louca
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
| | - Olatz Mompeo
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
| | - Emily R. Leeming
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
| | - Sarah E. Berry
- Department of Nutritional Sciences, King’s College London, London WC2R 2LS, UK;
| | - Massimo Mangino
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
- NIHR Biomedical Research Centre at Guy’s and St Thomas’ Foundation Trust, London SE1 9RT, UK
| | - Tim D. Spector
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
| | - Sandosh Padmanabhan
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Cristina Menni
- Department of Twin Research, King’s College London, St Thomas’ Hospital Campus, Westminster Bridge Road, London SE1 7EH, UK; (P.L.); (O.M.); (E.R.L.); (M.M.); (T.D.S.)
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Xu J, Yuan Q, Wu K, Li X, Zhao Y, Li X. Effects of Bailing capsule on diabetic nephropathy based on UPLC-MS urine metabolomics. RSC Adv 2019; 9:35969-35975. [PMID: 35540588 PMCID: PMC9074918 DOI: 10.1039/c9ra05046a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/23/2019] [Indexed: 11/21/2022] Open
Abstract
Diabetic nephropathy (DN) is one of the most common microvascular diabetes complications and has become a threat to human health. Bailing capsules (BLCs), containing fermentation products of Cordyceps sinensis, have been commonly used for treatment of renal dysfunction, such as DN. However, mechanisms underlying the protective effects of BLC remain largely obscure and await more investigation. In this study, UPLC-MS-based comprehensive metabolomics along with pattern recognition was applied to explore the urine metabolic alteration of DN as well as therapeutic mechanisms of BLC. Nineteen differentially expressed endogenous metabolites were identified related to DN, which were involved in the perturbations of tyrosine metabolism, tryptophan metabolism, glycine metabolism, purine metabolism, glutamine metabolism, phenylalanine metabolism, histidine metabolism and TCA cycle metabolism pathways. After drug intervention, most of the biomarkers exhibited a certain extent towards normal levels (P < 0.05), which indicated that BLC was an effective drug for treating DN and might play its therapeutic role by retrieving abnormal metabolism pathways. The data obtained in this research may pave the way for further exploration of DN and provide key clues to understand the protective effect of BLC. UPLC-MS-based metabolomics along with pattern recognition was applied to explore the metabolic alteration of diabetic nephropathy and therapeutic mechanisms of Bailing capsule.![]()
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Affiliation(s)
- Junnan Xu
- Department of Urology, The Organ Transplant Institute of PLA, The 8th Medical Center of Chinese PLA General Hospital Beijing 100091 China
| | - Qing Yuan
- Department of Urology, The Organ Transplant Institute of PLA, The 8th Medical Center of Chinese PLA General Hospital Beijing 100091 China
| | - Kang Wu
- Department of Urology, The Organ Transplant Institute of PLA, The 8th Medical Center of Chinese PLA General Hospital Beijing 100091 China
| | - Xiubin Li
- The Organ Transplant Institute of PLA, The 8th Medical Center of Chinese PLA General Hospital, Beijing Key Laboratory of Immunology Regulatory and Organ Transplantation Beijing 100091 China
| | - Yuanyu Zhao
- Department of Organ Transplantation, Shanghai Changzheng Hospital, Naval Medical University Shanghai 200003 China
| | - Xiang Li
- Department of Urology, The Organ Transplant Institute of PLA, The 8th Medical Center of Chinese PLA General Hospital Beijing 100091 China
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11
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Chen CJ, Liao WL, Chang CT, Lin YN, Tsai FJ. Identification of Urinary Metabolite Biomarkers of Type 2 Diabetes Nephropathy Using an Untargeted Metabolomic Approach. J Proteome Res 2018; 17:3997-4007. [PMID: 30265543 DOI: 10.1021/acs.jproteome.8b00644] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Diabetic nephropathy (DN) is one of the most common complications of diabetes mellitus (DM). To discover early stage biomarkers of DN, untargeted liquid chromatography-mass spectrometry-based metabolomic analysis was performed in urine samples from healthy subjects and patients with micro- or macroalbuminuria due to nondiabetic disease (macro), type 2 DM without microalbuminuria (T2DM), and type 2 DM with microalbuminuria (T2DM+micro). Levels of four metabolites were significantly different among groups, and they were quantified in a larger group of 267 urine samples. Two metabolites were also discovered and validated in targeted metabolic study of amino acids. For diagnosis of nephropathy, N1-methylguanosine had the highest area-under-the-curve (AUC) value of 0.75 when compared to those of valine (0.68), xanthosine (0.67), and 7-methyluric acid (0.69). After combining fasting blood glucose and diastolic blood pressure (DBP) with N1-methylguanosine, the AUC increased to 0.987. To distinguish between T2DM and T2DM+micro conditions, xanthosine and N1-methylguanosine have AUC value of 0.612 and 0.624, respectively. After adjustment of HbA1c and DBP, AUC values of xanthosine and N1-methylguanosine increased to 0.716 and 0.723, respectively, and could be used to predict the development of nephropathy in T2DM patients.
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Affiliation(s)
- Chao-Jung Chen
- Proteomics Core Laboratory, Department of Medical Research , China Medical University Hospital , Taichung 40447 , Taiwan.,Graduate Institute of Integrated Medicine , China Medical University , Taichung 40402 , Taiwan
| | - Wen-Ling Liao
- Graduate Institute of Integrated Medicine , China Medical University , Taichung 40402 , Taiwan.,Center for Personalized Medicine , China Medical University Hospital , Taichung 40447 , Taiwan
| | - Chiz-Tzung Chang
- College of Medicine , China Medical University , Taichung 40402 , Taiwan.,Division of Nephrology , China Medical University Hospital , Taichung 40447 , Taiwan
| | - Yu-Ning Lin
- Proteomics Core Laboratory, Department of Medical Research , China Medical University Hospital , Taichung 40447 , Taiwan
| | - Fuu-Jen Tsai
- Human Genetic Laboratory, Department of Medical Research , China Medical University Hospital , Taichung 40447 , Taiwan.,Department of Health and Nutrition Biotechnology , Asia University , Taichung 41354 , Taiwan.,School of Chinese Medicine , China Medical University , Taichung 40402 , Taiwan
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12
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Personalized Approach and Precision Medicine in Supportive and End-of-Life Care for Patients With Advanced and End-Stage Kidney Disease. Semin Nephrol 2018; 38:336-345. [PMID: 30082054 DOI: 10.1016/j.semnephrol.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Kidney supportive care requires a highly personalized approach to care. Precision medicine holds promise for a deeper understanding of the pathophysiology of symptoms and related syndromes and more precise individualization of prognosis and treatment estimates, therefore providing valuable opportunities for greater personalization of supportive care. However, the major drivers of quality of life are psychosocial, economic, lifestyle, and preference-based, and consideration of these factors and skilled communication are integral to the provision of excellent and personalized kidney supportive care. This article discusses the concepts of personalized and precision medicine in the context of kidney supportive care and highlights some opportunities and limitations within these fields.
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Kalim S, Wald R, Yan AT, Goldstein MB, Kiaii M, Xu D, Berg AH, Clish C, Thadhani R, Rhee EP, Perl J. Extended Duration Nocturnal Hemodialysis and Changes in Plasma Metabolite Profiles. Clin J Am Soc Nephrol 2018; 13:436-444. [PMID: 29444900 PMCID: PMC5967674 DOI: 10.2215/cjn.08790817] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 12/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES In-center, extended duration nocturnal hemodialysis has been associated with variable clinical benefits, but the effect of extended duration hemodialysis on many established uremic solutes and other components of the metabolome is unknown. We determined the magnitude of change in metabolite profiles for patients on extended duration nocturnal hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In a 52-week prospective, observational study, we followed 33 patients receiving conventional thrice weekly hemodialysis who converted to nocturnal hemodialysis (7-8 hours per session, three times per week). A separate group of 20 patients who remained on conventional hemodialysis (3-4 hours per session, three times per week) served as a control group. For both groups, we applied liquid chromatography-mass spectrometry-based metabolite profiling on stored plasma samples collected from all participants at baseline and after 1 year. We examined longitudinal changes in 164 metabolites among those who remained on conventional hemodialysis and those who converted to nocturnal hemodialysis using Wilcoxon rank sum tests adjusted for multiple comparisons (false discovery rate <0.05). RESULTS On average, the nocturnal group had 9.6 hours more dialysis per week than the conventional group. Among 164 metabolites, none changed significantly from baseline to study end in the conventional group. Twenty-nine metabolites changed in the nocturnal group, 21 of which increased from baseline to study end (including all branched-chain amino acids). Eight metabolites decreased after conversion to nocturnal dialysis, including l-carnitine and acetylcarnitine. By contrast, several established uremic retention solutes, including p-cresol sulfate, indoxyl sulfate, and trimethylamine N-oxide, did not change with extended dialysis. CONCLUSIONS Across a wide array of metabolites examined, extended duration hemodialysis was associated with modest changes in the plasma metabolome, with most differences relating to metabolite increases, despite increased dialysis time. Few metabolites showed reduction with more dialysis, and no change in several established uremic toxins was observed.
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Affiliation(s)
| | | | - Andrew T. Yan
- Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mercedeh Kiaii
- Division of Nephrology, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | | | - Anders H. Berg
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
| | | | | | - Eugene P. Rhee
- Nephrology Division and
- Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute, Cambridge, Massachusetts
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14
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Zhang ZH, Mao JR, Chen H, Su W, Zhang Y, Zhang L, Chen DQ, Zhao YY, Vaziri ND. Removal of uremic retention products by hemodialysis is coupled with indiscriminate loss of vital metabolites. Clin Biochem 2017; 50:1078-1086. [DOI: 10.1016/j.clinbiochem.2017.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
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15
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Argilés À, Rodriguez M, Ortiz A. Is Plasma Proteomics Able to Provide Alternative Paths to Better Understand Hypertension? Hypertension 2017; 70:250-252. [PMID: 28652468 DOI: 10.1161/hypertensionaha.117.09049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Àngel Argilés
- From the Néphrologie Dialyse Saint Guilhem, Sete, France (A.A.); RD - Néphrologie, Montpellier, France (A.A.); Mariano Rodriguez, IMIBIC, Nephrology Service Hospital Universitario Reina Sofia de Cordoba, Spain (M.R.); Red de Investigacion Renal (REDINREN), Madrid, Spain (M.R., A.O.); and IIS-Fundacion Jimenez Diaz UAM and FRIAT, Madrid, Spain (A.O.).
| | - Mariano Rodriguez
- From the Néphrologie Dialyse Saint Guilhem, Sete, France (A.A.); RD - Néphrologie, Montpellier, France (A.A.); Mariano Rodriguez, IMIBIC, Nephrology Service Hospital Universitario Reina Sofia de Cordoba, Spain (M.R.); Red de Investigacion Renal (REDINREN), Madrid, Spain (M.R., A.O.); and IIS-Fundacion Jimenez Diaz UAM and FRIAT, Madrid, Spain (A.O.)
| | - Alberto Ortiz
- From the Néphrologie Dialyse Saint Guilhem, Sete, France (A.A.); RD - Néphrologie, Montpellier, France (A.A.); Mariano Rodriguez, IMIBIC, Nephrology Service Hospital Universitario Reina Sofia de Cordoba, Spain (M.R.); Red de Investigacion Renal (REDINREN), Madrid, Spain (M.R., A.O.); and IIS-Fundacion Jimenez Diaz UAM and FRIAT, Madrid, Spain (A.O.)
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16
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Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease. Nutrients 2017; 9:nu9050489. [PMID: 28498348 PMCID: PMC5452219 DOI: 10.3390/nu9050489] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/22/2017] [Accepted: 05/09/2017] [Indexed: 12/24/2022] Open
Abstract
In chronic kidney disease (CKD), accumulation of uremic toxins is associated with an increased risk of death. Some uremic toxins are ingested with the diet, such as phosphate and star fruit-derived caramboxin. Others result from nutrient processing by gut microbiota, yielding precursors of uremic toxins or uremic toxins themselves. These nutrients include l-carnitine, choline/phosphatidylcholine, tryptophan and tyrosine, which are also sold over-the-counter as nutritional supplements. Physicians and patients alike should be aware that, in CKD patients, the use of these supplements may lead to potentially toxic effects. Unfortunately, most patients with CKD are not aware of their condition. Some of the dietary components may modify the gut microbiota, increasing the number of bacteria that process them to yield uremic toxins, such as trimethylamine N-Oxide (TMAO), p-cresyl sulfate, indoxyl sulfate and indole-3 acetic acid. Circulating levels of nutrient-derived uremic toxins are associated to increased risk of death and cardiovascular disease and there is evidence that this association may be causal. Future developments may include maneuvers to modify gut processing or absorption of these nutrients or derivatives to improve CKD patient outcomes.
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