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Ebersolt M, Santana Machado T, Mallmann C, Mc-Kay N, Dou L, Bouchouareb D, Brunet P, Burtey S, Sallée M. Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients. Toxins (Basel) 2022; 14:toxins14090589. [PMID: 36136527 PMCID: PMC9502511 DOI: 10.3390/toxins14090589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/09/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Indoxyl sulfate (IS) and p-cresyl sulfate (PCS), two uremic toxins (UTs), are associated with increased mortality in patients with chronic kidney disease (CKD). These toxins are produced by the microbiota from the diet and excreted by the kidney. The purpose of this study was to analyze the effect of diet on IS and PCS concentration in hemodialysis (HD) patients. Methods: We performed a prospective monocentric study using a seven-day diet record and determination of serum IS and PCS levels in HD patients. We tested the association between toxin concentrations and nutritional data. Results: A total of 58/75 patients (77%) completed the diet record. Mean caloric intake was 22 ± 9.2 kcal/kg/day. The protein/fiber index was 4.9 ± 1.8. No correlation between IS or PCS concentration and protein/fiber index was highlighted. In the 18 anuric patients (31%) in whom residual renal function could not affect toxin concentrations, IS and PCS concentrations were negatively correlated with fiber intake and positively correlated with the protein/fiber index. In a multivariate analysis, IS serum concentration was positively associated with the protein/fiber index (p = 0.03). Conclusions: A low protein/fiber index is associated with low concentrations of uremic toxins in anuric HD patients. Diets with an increased fiber intake must be tested to determine whether they reduce PCS and IS serum concentrations.
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Affiliation(s)
- Manon Ebersolt
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France
| | | | - Cecilia Mallmann
- Centre D’investigation Clinique, Hôpital de la Conception, 13005 Marseille, France
| | - Nathalie Mc-Kay
- Aix Marseille Univ, INSERM, INRAE, C2VN, 13005 Marseille, France
| | - Laetitia Dou
- Aix Marseille Univ, INSERM, INRAE, C2VN, 13005 Marseille, France
| | - Dammar Bouchouareb
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, 13005 Marseille, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, 13005 Marseille, France
- Correspondence:
| | - Marion Sallée
- Centre de Néphrologie et Transplantation Rénale, AP-HM, Hôpital de la Conception, 147 Bd Baille, 13005 Marseille, France
- Aix Marseille Univ, INSERM, INRAE, C2VN, 13005 Marseille, France
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Chen CH, Huang SC, Yeh EL, Lin PC, Tsai SF, Huang YC. Indoxyl sulfate, homocysteine, and antioxidant capacities in patients at different stages of chronic kidney disease. Nutr Res Pract 2022; 16:464-475. [PMID: 35919290 PMCID: PMC9314193 DOI: 10.4162/nrp.2022.16.4.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/01/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVES Increased levels of uremic toxins and decreased antioxidant capacity have a significant impact on the progression of chronic kidney disease (CKD). However, it remains unclear whether they interact with each other to mediate the damage of kidney function. The purpose of this study was to investigate whether uremic toxins (i.e., homocysteine and indoxyl sulfate [IS]), as well as glutathione-dependent antioxidant enzyme activities are dependently or independently associated with kidney function during different stages of CKD patients. SUBJECTS/METHODS One hundred thirty-two patients diagnosed with CKD at stages 1 to 5 participated in this cross-sectional study. RESULTS Patients who had reached an advanced CKD stage experienced an increase in plasma uremic toxin levels, along with decreased glutathione peroxidase (GSH-Px) activity. Plasma homocysteine, cysteine, and IS concentrations were all positively associated with each other, but negatively correlated to GSH-Px activity levels after adjusting for potential confounders in all CKD patients. Although plasma homocysteine, cysteine, IS, and GSH-Px levels were significantly associated with kidney function, only plasma IS levels still had a significant association with kidney function after these parameters were simultaneously adjusted. In addition, plasma IS could interact with GSH-Px activity to be associated with kidney function. CONCLUSIONS IS plays a more dominant role than homocysteine and GSH-Px activity in relation to kidney function.
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Affiliation(s)
- Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- School of Medicine, China Medical University, Taichung 404333, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Shih-Chien Huang
- Department of Nutrition, Chung Shan Medical University, Taichung 402306, Taiwan
- Department of Nutrition, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
- Department of Health Industry Technology Management, Chung Shan Medical University, Taichung 402306, Taiwan
| | - En-Ling Yeh
- Department of Nutrition, College of Medical and Health Care, Hung-Kuang University, Taichung 433304, Taiwan
| | - Pei-Chih Lin
- Department of Nutrition, Chung Shan Medical University, Taichung 402306, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 112304, Taiwan
| | - Yi-Chia Huang
- Department of Nutrition, Chung Shan Medical University, Taichung 402306, Taiwan
- Department of Nutrition, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
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Hoogeveen RM, Verweij SL, Kaiser Y, Kroon J, Verberne HJ, Vogt L, Moens SJB, Stroes ESG. Atorvastatin treatment does not abolish inflammatory mediated cardiovascular risk in subjects with chronic kidney disease. Sci Rep 2021; 11:4126. [PMID: 33602971 PMCID: PMC7892998 DOI: 10.1038/s41598-021-83273-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/27/2021] [Indexed: 11/26/2022] Open
Abstract
Individuals with chronic kidney disease are at an increased risk for cardiovascular disease. This risk may partially be explained by a chronic inflammatory state in these patients, reflected by increased arterial wall and cellular inflammation. Statin treatment decreases cardiovascular risk and arterial inflammation in non-CKD subjects. In patients with declining kidney function, cardiovascular benefit resulting from statin therapy is attenuated, possibly due to persisting inflammation. In the current study, we assessed the effect of statin treatment on arterial wall and cellular inflammation. Fourteen patients with chronic kidney disease stage 3 or 4, defined by an estimated Glomerular Filtration Rate between 15 and 60 mL/min/1.73 m2, without cardiovascular disease were included in a single center, open label study to assess the effect of atorvastatin 40 mg once daily for 12 weeks (NTR6896). At baseline and at 12 weeks of treatment, we assessed arterial wall inflammation by 18F-fluoro-deoxyglucose positron-emission tomography computed tomography (18F-FDG PET/CT) and the phenotype of circulating monocytes were assessed. Treatment with atorvastatin resulted in a 46% reduction in LDL-cholesterol, but this was not accompanied by an attenuation in arterial wall inflammation in the aorta or carotid arteries, nor with changes in chemokine receptor expression of circulating monocytes. Statin treatment does not abolish arterial wall or cellular inflammation in subjects with mild to moderate chronic kidney disease. These results imply that CKD-associated inflammatory activity is mediated by factors beyond LDL-cholesterol and specific anti-inflammatory interventions might be necessary to further dampen the inflammatory driven CV risk in these subjects.
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Affiliation(s)
- Renate M Hoogeveen
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Simone L Verweij
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yannick Kaiser
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jeffrey Kroon
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Liffert Vogt
- Department of Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie J Bernelot Moens
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Qu W, Nie C, Zhao J, Ou X, Zhang Y, Yang S, Bai X, Wang Y, Wang J, Li J. Microbiome-Metabolomics Analysis of the Impacts of Long-Term Dietary Advanced-Glycation-End-Product Consumption on C57BL/6 Mouse Fecal Microbiota and Metabolites. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2018; 66:8864-8875. [PMID: 30037223 DOI: 10.1021/acs.jafc.8b01466] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Thermally processed diets are widely consumed, although advanced-glycation end products (AGEs) are unavoidably formed. AGEs, clusters of protein-cross-linking products, become less digestible because they impair intestinal peptidase proteolysis. We characterized the impacts of dietary AGEs on gut microbiota through a microbiome-to-metabolome association study. C57BL/6 mice were fed a heat-treated diet (high-AGE diet, H-AGE) or a standard AIN-93G diet (low-AGE diet, L-AGE) for 8 months. Fecal-microbiota composition was examined by 16S rDNA sequencing, and fecal-metabolome profile was evaluated by gas chromatography-tandem time-of-flight mass spectrometry (GC-TOF-MS). Reduced α-diversity and altered microbiota composition with elevated Helicobacter levels were found in the H-AGE group, and among the 57 perturbed metabolites, protein-fermentation products (i.e., p-cresol and putrescine) were increased. Major dysfunctional metabolic pathways were associated with carbohydrate and amino acid metabolism in two groups. Moreover, high correlations were found between fluctuant gut microbiota and metabolites. These findings might reveal the underlying mechanisms of the detrimental impacts of dietary AGEs on host health.
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Affiliation(s)
- Wanting Qu
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Chenxi Nie
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Jinsong Zhao
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Xiyang Ou
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Yingxiao Zhang
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Shanchun Yang
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Xue Bai
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
| | - Yong Wang
- Shaanxi Research Institute of Agricultural Products Processing Technology , Xi'an , Shaanxi Province 710016, PR China
- Shaanxi University of Science and Technology , Xi'an , Shaanxi Province 710016 , PR China
| | - Jiawei Wang
- Shaanxi University of Science and Technology , Xi'an , Shaanxi Province 710016 , PR China
| | - Juxiu Li
- College of Food Science and Engineering , Northwest A&F University , 22 Xinong Road , Yangling , Shaanxi Province 712100 , PR China
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Crespo-Salgado J, Vehaskari VM, Stewart T, Ferris M, Zhang Q, Wang G, Blanchard EE, Taylor CM, Kallash M, Greenbaum LA, Aviles DH. Intestinal microbiota in pediatric patients with end stage renal disease: a Midwest Pediatric Nephrology Consortium study. MICROBIOME 2016; 4:50. [PMID: 27640125 PMCID: PMC5027112 DOI: 10.1186/s40168-016-0195-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/06/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) is associated with uremia and increased systemic inflammation. Alteration of the intestinal microbiota may facilitate translocation of endotoxins into the systemic circulation leading to inflammation. We hypothesized that children with ESRD have an altered intestinal microbiota and increased serum levels of bacterially derived uremic toxins. METHODS Four groups of subjects were recruited: peritoneal dialysis (PD), hemodialysis (HD), post-kidney transplant and healthy controls. Stool bacterial composition was assessed by pyrosequencing analysis of 16S rRNA genes. Serum levels of C-reactive protein (CRP), D-lactate, p-cresyl sulfate and indoxyl sulfate were measured. RESULTS Compared to controls, the relative abundance of Firmicutes (P = 0.0228) and Actinobacteria (P = 0.0040) was decreased in PD patients. The relative abundance of Bacteroidetes was increased in HD patients (P = 0.0462). Compared to HD patients the relative abundance of Proteobacteria (P = 0.0233) was increased in PD patients. At the family level, Enterobacteriaceae was significantly increased in PD patients (P = 0.0020) compared to controls; whereas, Bifidobacteria showed a significant decrease in PD and transplant patients (P = 0.0020) compared to control. Alpha diversity was decreased in PD patients and kidney transplant using both phylogenetic and non-phylogenetic diversity measures (P = 0.0031 and 0.0003, respectively), while beta diversity showed significant separation (R statistic = 0.2656, P = 0.010) between PD patients and controls. ESRD patients had increased serum levels of p-cresyl sulfate and indoxyl sulfate (P < 0.0001 and P < 0.0001, respectively). The data suggests that no significant correlation exists between the alpha diversity of the intestinal microbiota and CRP, D-lactate, or uremic toxins. Oral iron supplementation results in expansion of the phylum Proteobacteria. CONCLUSIONS Children with ESRD have altered intestinal microbiota and increased bacterially derived serum uremic toxins.
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Affiliation(s)
- Janice Crespo-Salgado
- Children's Hospital, New Orleans, LA, USA
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - V Matti Vehaskari
- Children's Hospital, New Orleans, LA, USA
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tyrus Stewart
- Children's Hospital, New Orleans, LA, USA
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Michael Ferris
- Children's Hospital, New Orleans, LA, USA
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Qiang Zhang
- Xavier University of Louisiana, New Orleans, LA, USA
| | - Guangdi Wang
- Xavier University of Louisiana, New Orleans, LA, USA
| | | | | | | | - Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Diego H Aviles
- Children's Hospital, New Orleans, LA, USA.
- Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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Karbowska M, Kaminski T, Pawlak D. Methods of reducing the level of indoxyl sulfate – one of the most potent protein-bound uremic toxins. TOXIN REV 2016. [DOI: 10.1080/15569543.2016.1222442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rossi M, Johnson DW, Morrison M, Pascoe EM, Coombes JS, Forbes JM, Szeto CC, McWhinney BC, Ungerer JPJ, Campbell KL. Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY): A Randomized Trial. Clin J Am Soc Nephrol 2016; 11:223-31. [PMID: 26772193 DOI: 10.2215/cjn.05240515] [Citation(s) in RCA: 245] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 11/02/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES The generation of key uremic nephrovascular toxins, indoxyl sulfate (IS), and p-cresyl sulfate (PCS), is attributed to the dysbiotic gut microbiota in CKD. The aim of our study was to evaluate whether synbiotic (pre- and probiotic) therapy alters the gut microbiota and reduces serum concentrations of microbiome-generated uremic toxins, IS and PCS, in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Predialysis adult participants with CKD (eGFR=10-30 ml/min per 1.73 m(2)) were recruited between January 5, 2013 and November 12, 2013 to a randomized, double-blind, placebo-controlled, crossover trial of synbiotic therapy over 6 weeks (4-week washout). The primary outcome was serum IS. Secondary outcomes included serum PCS, stool microbiota profile, eGFR, proteinuria-albuminuria, urinary kidney injury molecule-1, serum inflammatory biomarkers (IL-1β, IL-6, IL-10, and TNF-α), serum oxidative stress biomarkers (F2-isoprostanes and glutathione peroxidase), serum LPS, patient-reported health, Gastrointestinal Symptom Score, and dietary intake. A prespecified subgroup analysis explored the effect of antibiotic use on treatment effect. RESULTS Of 37 individuals randomized (age =69±10 years old; 57% men; eGFR=24±8 ml/min per 1.73 m(2)), 31 completed the study. Synbiotic therapy did not significantly reduce serum IS (-2 μmol/L; 95% confidence interval [95% CI], -5 to 1 μmol/L) but did significantly reduce serum PCS (-14 μmol/L; 95% CI, -27 to -2 μmol/L). Decreases in both PCS and IS concentrations were more pronounced in patients who did not receive antibiotics during the study (n=21; serum PCS, -25 μmol/L; 95% CI, -38 to -12 μmol/L; serum IS, -5 μmol/L; 95% CI, -8 to -1 μmol/L). Synbiotics also altered the stool microbiome, particularly with enrichment of Bifidobacterium and depletion of Ruminococcaceae. Except for an increase in albuminuria of 38 mg/24 h (P=0.03) in the synbiotic arm, no changes were observed in the other secondary outcomes. CONCLUSION In patients with CKD, synbiotics did not significantly reduce serum IS but did decrease serum PCS and favorably modified the stool microbiome. Large-scale clinical trials are justified.
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Affiliation(s)
- Megan Rossi
- School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia; Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia;
| | - David W Johnson
- School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia; Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mark Morrison
- Translational Research Institute, Brisbane, Queensland, Australia; Diamantina Institute
| | | | | | - Josephine M Forbes
- School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia; Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Cheuk-Chun Szeto
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; and
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Jacobus P J Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia; Nephrology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Rossi M, Johnson DW, Xu H, Carrero JJ, Pascoe E, French C, Campbell KL. Dietary protein-fiber ratio associates with circulating levels of indoxyl sulfate and p-cresyl sulfate in chronic kidney disease patients. Nutr Metab Cardiovasc Dis 2015; 25:860-865. [PMID: 26026209 DOI: 10.1016/j.numecd.2015.03.015] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/25/2015] [Accepted: 03/30/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are uremic toxins derived solely from colonic bacterial fermentation of protein. Dietary fiber may counteract this by limiting proteolytic bacterial fermentation. However, the influence of dietary intake on the generation of IS and PCS has not been adequately explored in chronic kidney disease (CKD). METHODS AND RESULTS This cross-sectional study included 40 CKD participants (60% male; age 69 ± 10 years; 45% diabetic) with a mean estimated glomerular filtration rate (eGFR) of 24 ± 8 mL/min/1.73 m(2), who enrolled in a randomized controlled trial of synbiotic therapy. Total and free serum IS and PCS were measured at baseline by ultra-performance liquid chromatography. Dietary intake was measured using in-depth diet histories collected by a dietitian. Associations between each toxin, dietary fiber (total, soluble and insoluble), dietary protein (total, and amino acids: tryptophan, tyrosine and phenylalanine), and the protein-fiber index (ratio of protein to fiber) were assessed using linear regression. Dietary fiber was associated with free and total serum PCS (r = -0.42 and r = -0.44, both p < 0.01), but not IS. No significant association was observed between dietary protein and either toxin. The protein-fiber index was associated with total serum IS (r = 0.40, p = 0.012) and PCS (r = 0.43, p = 0.005), independent of eGFR, sex and diabetes. CONCLUSION Dietary protein-fiber index is associated with serum IS and PCS levels. Such association, beyond fiber and protein alone, highlights the importance of the interplay between these nutrients. We speculate that dietary modification towards a lower protein-fiber index may contribute to lowering IS and PCS.
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Affiliation(s)
- M Rossi
- Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia.
| | - D W Johnson
- Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
| | - H Xu
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - J J Carrero
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - E Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - C French
- Princess Alexandra Hospital, Brisbane, Australia
| | - K L Campbell
- Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia; Translational Research Institute, Brisbane, Australia
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Rossi M, Johnson DW, Campbell KL. The Kidney–Gut Axis: Implications for Nutrition Care. J Ren Nutr 2015; 25:399-403. [DOI: 10.1053/j.jrn.2015.01.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 12/30/2014] [Accepted: 01/05/2015] [Indexed: 02/08/2023] Open
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Rossi M, Campbell K, Johnson D, Stanton T, Pascoe E, Hawley C, Dimeski G, McWhinney B, Ungerer J, Isbel N. Uraemic toxins and cardiovascular disease across the chronic kidney disease spectrum: an observational study. Nutr Metab Cardiovasc Dis 2014; 24:1035-1042. [PMID: 24880738 DOI: 10.1016/j.numecd.2014.04.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/12/2014] [Accepted: 04/08/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS There is a growing body of evidence supporting the nephrovascular toxicity of indoxyl sulphate (IS) and p-cresyl sulphate (PCS). Nonetheless, a comprehensive description of how these toxins accumulate over the course of chronic kidney disease (CKD) is lacking. METHODS AND RESULTS This cross-sectional observational study included a convenience sample of 327 participants with kidney function categorised as normal, non-dialysis CKD and end-stage kidney disease (ESKD). Participants underwent measurements of serum total and free IS and PCS and assessment of cardiovascular history and structure (carotid intima-media thickness [cIMT, a measure of arterial stiffness]), and endothelial function (brachial artery reactivity [flow-mediated dilation (BAR-FMD); glyceryl trinitrate (BAR-GTN)]). Across the CKD spectrum there was a significant increase in both total and free IS and PCS and their free fractions, with the highest levels observed in the ESKD population. Within each CKD stage, concentrations of PCS, total and free, were significantly greater than IS (all p < 0.01). Both IS and PCS, free and total, were correlated with BAR-GTN (ranging from r = -0.33 to -0.44) and cIMT (r = 0.19 to 0.21), even after adjusting for traditional risk factors (all p < 0.01). Further, all toxins were independently associated with the presence of cardiovascular disease (all p < 0.02). CONCLUSION More advanced stages of CKD are associated with progressive increases in total and free serum IS and PCS, as well as increases in their free fractions. Total and free serum IS and PCS were independently associated with structural and functional markers of cardiovascular disease. Studies of therapeutic interventions targeting these uraemic toxins are warranted.
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Affiliation(s)
- M Rossi
- School of Medicine, University of Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | - K Campbell
- School of Medicine, University of Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D Johnson
- School of Medicine, University of Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - T Stanton
- School of Medicine, University of Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - E Pascoe
- School of Medicine, University of Queensland, Australia
| | - C Hawley
- School of Medicine, University of Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - G Dimeski
- School of Medicine, University of Queensland, Australia; Department of Chemical Pathology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B McWhinney
- Department of Chemical Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - J Ungerer
- Department of Chemical Pathology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - N Isbel
- School of Medicine, University of Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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11
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Rossi M, Johnson DW, Morrison M, Pascoe E, Coombes JS, Forbes JM, McWhinney BC, Ungerer JPJ, Dimeski G, Campbell KL. SYNbiotics Easing Renal failure by improving Gut microbiologY (SYNERGY): a protocol of placebo-controlled randomised cross-over trial. BMC Nephrol 2014; 15:106. [PMID: 24996842 PMCID: PMC4094543 DOI: 10.1186/1471-2369-15-106] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease (CKD) through pre- and/probiotic supplementation may inhibit the development of key nephrovascular toxins. To date, quality intervention trials investigating this novel treatment in CKD are lacking. The aim of SYNERGY is to assess the effectiveness of synbiotics (co-administration of pre- and probiotics) as a potential treatment targeting the synthesis of uremic toxins, specifically, indoxyl sulphate (IS) and p-cresyl sulphate (PCS). METHODS/DESIGN Thirty-seven patients with moderate to severe CKD (Stage IV and V, pre-dialysis) will be recruited to a double-blind, placebo-controlled, randomised cross-over trial. Patients will be provided with synbiotic therapy or placebo for 6 weeks, with a 4 week washout before cross-over. The primary outcome is serum IS, total and free (unbound) concentrations, measured using ultra-performance liquid chromatography. Secondary outcomes include serum PCS, total and free (unbound) concentrations; cardiovascular risk, measured by serum lipopolysaccharides, serum trimethylamine-N-oxide (TMAO) and inflammation and oxidative stress markers; kidney damage, measured by 24 hour proteinuria and albuminuria, estimated glomerular filtration rate and renal tubule damage (urinary kidney injury molecule-1); patients' self assessed quality of life; and gastrointestinal symptoms. In addition, the effects on the community structure of the stool microbiota will be explored in a subset of patients to validate the mechanistic rationale underpinning the synbiotic therapy. DISCUSSION IS and PCS are two novel uremic toxins implicated in both cardiovascular disease (CVD) and progression of CKD. Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted, tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations. This trial will provide high quality 'proof-of-concept' data to elucidate both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits. Considering the potential of pre- and probiotics to not only shift toxin levels, but to also impede CVD and CKD progression, SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy. TRIAL REGISTRATION Universal Trial Number: U1111-1142-4363. Australian New Zealand Clinical Trials Registry Number: ACTRN12613000493741, date registered: 2nd May 2013.
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Affiliation(s)
- Megan Rossi
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - David W Johnson
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Mark Morrison
- Diamantina Institute, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
| | - Elaine Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Jeff S Coombes
- Human Movement Studies, University of Queensland, Brisbane, Australia
| | - Josephine M Forbes
- Translational Research Institute, Brisbane, Australia
- Mater Medical Research Institute, Brisbane, Australia
| | - Brett C McWhinney
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Jacobus PJ Ungerer
- Department of Chemical Pathology, Pathology Queensland, Brisbane, Australia
| | - Goce Dimeski
- School of Medicine, University of Queensland, Brisbane, Australia
- Chemical Pathology, Princess Alexandra Hospital, Brisbane, Australia
| | - Katrina L Campbell
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
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