Is there a relationship between tryptophan dietary intake and plasma levels of
            indoxyl sulfate in chronic kidney disease patients on hemodialysis?

Brito, Jessyca Sousa de; Borges, Natália Alvarenga; Dolenga, Carla Juliana Ribeiro; Carraro-Eduardo, José Carlos; Nakao, Lia S.; Mafra, Denise

doi:10.5935/0101-2800.20160064

Cited by 14 publications

(10 citation statements)

References 22 publications

(24 reference statements)

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“…A major weakness of this study was that the tryptophan intake was only parameter evaluated by a 24-h dietary recall performed on 3 different days. This dietary recall could be less accurate than expected and have only provided a “proxy” of tryptophan intake [ 80 ]. All these emerging strategies have not been tested in CKD and further studies will be necessary to confirm these nutritional options.…”

Section: Role Of Dietary Restrictions On Urs Productionmentioning

confidence: 99%

The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

Koppe

Fouque

Soulage

2018

Toxins

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Uremic retention solutes (URS) are associated with cardiovascular complications and poor survival in chronic kidney disease. The better understanding of the origin of a certain number of these toxins enabled the development of new strategies to reduce their production. URS can be classified according to their origins (i.e., host, microbial, or exogenous). The discovery of the fundamental role that the intestinal microbiota plays in the production of many URS has reinstated nutrition at the heart of therapeutics to prevent the accumulation of URS and their deleterious effects. The intestinal microbiota is personalized and is strongly influenced by dietary habits, such as the quantity and the quality of dietary protein and fibers. Herein, this review out lines the role of intestinal microbiota on URS production and the recent discoveries on the effect of diet composition on the microbial balance in the host with a focus on the effect on URS production.

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Section: Role Of Dietary Restrictions On Urs Productionmentioning

confidence: 99%

The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

Koppe

Fouque

Soulage

2018

Toxins

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“…24 These findings help explain the relationship between food intake and uremic toxins production by the intestinal microbiota, which therefore reinforces the importance of implementing nutritional strategies to delay the progression of CKD and cardiovascular adverse outcome, since uremic toxins are important predictors of such events. On the other hand, Brito et al (2016) found no association between the levels of indoxyl sulfate and the intake of its precursor, the amino acid tryptophan, in hemodialysis patients. However, the authors noted that the protein intake was below the recommended values for these patients, and the tryptophan intake was close to the recommendations in the Dietary Reference Intakes (DRI), 35 differently from the patients in the present study, who presented high protein intake (for patients with CKD under conservative treatment) and the investigated amino acids.…”

Section: Discussionmentioning

confidence: 75%

“…On the other hand, Brito et al (2016) found no association between the levels of indoxyl sulfate and the intake of its precursor, the amino acid tryptophan, in hemodialysis patients. However, the authors noted that the protein intake was below the recommended values for these patients, and the tryptophan intake was close to the recommendations in the Dietary Reference Intakes (DRI), 35 differently from the patients in the present study, who presented high protein intake (for patients with CKD under conservative treatment) and the investigated amino acids. Toden et al (2005) reported an increase in the production of uremic toxins, including PCS, in rats fed a highprotein diet.…”

Section: Discussionmentioning

confidence: 75%

Dietary intake of tyrosine and phenylalanine, and p-cresyl sulfate plasma levels in non-dialyzed patients with chronic kidney disease

et al. 2020

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Background: Patients with chronic kidney disease (CKD) present an imbalance of the gut microbiota composition, leading to increased production of uremic toxins like p-cresyl sulfate (PCS), product from bacterial fermentation of the amino acids tyrosine (Tyr) and phenylalanine (Phe) from the diet. Thus, diet may be a determinant in the uremic toxins levels produced by the gut microbiota. The aim of this study was to evaluate the possible relationship between Tyr and Phe intake and PCS plasma levels in non-dialysis CKD patients. Methods: Twenty-seven non-dialysis CKD patients (stages 3 and 4) without previous nutritional intervention were evaluated. The dietary intake was evaluated using a 24-hour recall, 3-day food record and protein intake was also estimated by Protein Nitrogen Appearance (PNA). The plasma levels of PCS were measured using reverse phase high performance liquid chromatography. Results: The evaluated patients (GRF, 34.8 ± 12.4 mL/min, 54.2 ± 14.3 years, BMI, 29.3 ± 6.1 kg/m2) presented mean protein intake of 1.1 ± 0.5 g/kg/day), Tyr of 4.5 ± 2.4 g/day and Phe of 4.6 ± 2.5 g/day. PCS plasma levels (20.4 ± 15.5 mg/L) were elevated and positively associated with both, Tyr (r = 0.58, p = 0.002) and Phe intake (r = 0.53, p = 0.005), even after adjustments for eGFR and age. Conclusion: This study suggests that the diet is an important modulator of the uremic toxins plasma levels produced by the gut microbiota, in non-dialysis CKD patients.

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“…In healthy subjects, an oral Trp overload leads to a transient increase in serum Trp [6]. However, earlier studies did not find any associations between plasma Trp concentration and Trp intake in dialysis patients, suggesting a key role for gut microbiota and liver in metabolizing dietary Trp [12,32]. Since our study enrolled participants from different centres across Europe, different dietary habits and differences in gut microbiota can be considered.…”

Section: Discussionmentioning

confidence: 83%

Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients

Paats

Adoberg

Arund

et al. 2020

IJMS

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Tryptophan is an essential dietary amino acid that originates uremic toxins that contribute to end-stage kidney disease (ESKD) patient outcomes. We evaluated serum levels and removal during haemodialysis and haemodiafiltration of tryptophan and tryptophan-derived uremic toxins, indoxyl sulfate (IS) and indole acetic acid (IAA), in ESKD patients in different dialysis treatment settings. This prospective multicentre study in four European dialysis centres enrolled 78 patients with ESKD. Blood and spent dialysate samples obtained during dialysis were analysed with high-performance liquid chromatography to assess uremic solutes, their reduction ratio (RR) and total removed solute (TRS). Mean free serum tryptophan and IS concentrations increased, and concentration of IAA decreased over pre-dialysis levels (67%, 49%, −0.8%, respectively) during the first hour of dialysis. While mean serum total urea, IS and IAA concentrations decreased during dialysis (−72%, −39%, −43%, respectively), serum tryptophan levels increased, resulting in negative RR (−8%) towards the end of the dialysis session (p < 0.001), despite remarkable Trp losses in dialysate. RR and TRS values based on serum (total, free) and dialysate solute concentrations were lower for conventional low-flux dialysis (p < 0.001). High-efficiency haemodiafiltration resulted in 80% higher Trp losses than conventional low-flux dialysis, despite similar neutral Trp RR values. In conclusion, serum Trp concentrations and RR behave differently from uremic solutes IS, IAA and urea and Trp RR did not reflect dialysis Trp losses. Conventional low-flux dialysis may not adequately clear Trp-related uremic toxins while high efficiency haemodiafiltration increased Trp losses.

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Is there a relationship between tryptophan dietary intake and plasma levels of indoxyl sulfate in chronic kidney disease patients on hemodialysis?

Cited by 14 publications

References 22 publications

The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

Dietary intake of tyrosine and phenylalanine, and p-cresyl sulfate plasma levels in non-dialyzed patients with chronic kidney disease

Serum Levels and Removal by Haemodialysis and Haemodiafiltration of Tryptophan-Derived Uremic Toxins in ESKD Patients

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