Introduction: Many of the deleterious effects associated with chronic kidney disease (CKD) are secondary to the resultant systemic inflammation. The gut microbial changes caused by CKD are thought to perpetuate systemic inflammation. Therefore, strategies aimed at modulating the gut microbiota may be helpful in reducing complications associated with CKD. We hypothesized that supplementation with high‐amylose maize resistant starch type 2 (HAM‐RS2) would beneficially alter the gut microbiome and lead to lower levels of systemic inflammation.
Methods: A double‐blind, parallel, randomized, placebo‐controlled trial was performed comparing dietary supplementation of HAM‐RS2 with placebo in patients with end‐stage CKD. Fecal microbial data were obtained from a subset of patients after DNA extraction and 16s sequencing.
Findings: Supplementation of HAM‐RS2 led to a decrease in serum urea, IL‐6, TNFα, and malondialdehyde (P < 0.05). The Faecalibacterium genus was significantly increased in relative abundance following HAM‐RS2 supplementation (HAM‐RS2‐Day 0: 0.40 ± 0.50 vs. HAM‐RS2‐Day 56: 3.21 ± 4.97 P = 0.03) and was unchanged by placebo (Control‐Day 0: 0.72 ± 0.72 vs. Control‐Day 56: 0.83 ± 1.57 P = 0.5).
Discussion: Supplementation of amylose resistant starch, HAM‐RS2, in patients with CKD led to an elevation in Faecalibacterium and decrease in systemic inflammation. Microbial manipulation in CKD patients by using the prebiotic fiber may exert an anti‐inflammatory effect through an elevation in the bacterial genera Faecalibacterium.
Administration of HAM-RS2 for eight weeks significantly reduced levels of inflammatory and oxidative markers in hemodialysis patients confirming the results observed in CKD animals. Long term trials are needed to explore the impact of HAM-RS2 supplementation on clinical outcomes in end stage renal disease population.
IntroductionGut derived toxins such as p-cresol, p-cresyl sulfate (pCS) and indoxyl sulfate (IS), which belong to protein-bound uremic toxins that promote development of fibrosis inflammatory state associated with chronic kidney disease. One possible way to suppress the production of IS and pCS is to increase dietary fiber intake. The aim of the present study was to assess whether increasing dietary fiber, as high amylose diet, can affect the level of conventional and protein bound nitrogenous products.MethodsFifty patients with end stage renal disease (ESRD) on maintenance hemodialysis were randomly assigned to receive a diet containing resistant starch (HAM-RS2) or placebo over 8 weeks spanning February and September 2017 in the 29 Bahman hospital hemodialysis ward in Tabriz, Iran. Of these, 44 patients (23 from HAM-RS2 and 21 control) completed the study. Plasma levels of urea, creatinine, uric acid and other routine parameters were measured at the beginning and after 8 weeks of starting the supplementation. The levels of IS and p-cresol in the collected serum samples were also determined by HPLC at baseline and after intervention.ResultsThere was significant reduction of creatinine and uric acid levels in HAM-RS2 supplemented patients when compared with control group (P < 0.05). Serum levels of IS was not changed significantly in both HAM-RS2 treated and control patients, whereas p-cresol level was reduced significantly during the study period in HAM-RS2 treated patients (P = 0.039). The change of other parameters including Hb, lipids, bone markers and hs-CRP were non-significant during the study in both groups.ConclusionAdministration of fermentable high fiber diet as HAM-RS2 decreased serum levels of some nitrogenous products such as serum creatinine and p-cresol as a gut derived nitrogenous product without change in IS levels in maintenance hemodialysis patients. Due to safety, without important side effects the administration of diet enriched with fermentable fiber is suitable for patients on maintenance dialysis.
In the past few decades, several studies have reported the physiological effects of listening to music. The physiological effects of different music types on different people are not similar. Therefore, in the present study, we have sought to examine the effects of traditional Persian music on the cardiac function in young women. Twenty-two healthy females participated in this study. ECG signals were recorded in two conditions: rest and music. For each of the 21 ECG signals (15 morphological and six wavelet based feature) features were extracted. SVM classifier was used for the classification of ECG signals during and before the music. The results showed that the mean of heart rate, the mean amplitude of R-wave, T-wave, and P-wave decreased in response to music. Time-frequency analysis revealed that the mean of the absolute values of the detail coefficients at higher scales increased during rest. The overall accuracy of 91.6% was achieved using polynomial kernel and RBF kernel. Using linear kernel, the best result (with the accuracy rate of 100%) was attained.
At the present time, imaging guided renal biopsy is used to provide diagnoses in most types of primary and secondary renal diseases. It has been claimed that renal biopsy can provide a link between diagnosis of renal disease and its pathological conditions. However, sometimes there is a considerable mismatch between patient renal outcome and pathological findings in renal biopsy. This is the time to address some new diagnostic methods to resolve the insufficiency of conventional percutaneous guided renal biopsy. Nanotechnology is still in its infancy in renal imaging; however, it seems that it is the next step in renal biopsy, providing solutions to the limitations of conventional modalities.
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