Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis

Jia, Linpei; Dong, Xingtong; Li, Xiaoxia; Jia, Rufu; Zhang, Hong‐Liang

doi:10.7150/ijms.51484

Cited by 12 publications

(13 citation statements)

References 61 publications

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“…A similar review by Jia et al 31 examined the effects of type 2 RS in patients with kidney failure undergoing hemodialysis and conducted a meta-analysis. However, it is our understanding that they meta-analyzed data from the same heterogeneous study populations and may have included incorrectly reported data, as mentioned in the “Results” section.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Resistant Starch Consumption in Adult Patients With Chronic Kidney Disease: A Systematic Review

Kingra

Curtis

Mollard

et al. 2022

Can J Kidney Health Dis

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Background: Resistant starches (RSs) are not digested by human digestive enzymes and pass through the upper digestive tract to become substrates for colonic bacteria. Resistant starch supplementation has shown promising results in altering the microbiota of animal models of chronic kidney disease (CKD). Resistant starch consumption may influence the production of uremic toxins in CKD. Objective: To conduct a systematic review to determine whether the consumption of RS reduces the progression of kidney disease in adult patients with CKD. Design: We included randomized controlled trials comparing RS supplementation to placebo, no treatment, or standard care. Cochrane Central, Embase, MEDLINE, Web of Science, and CINAHL databases were searched. There was no limitation on publication date, but only English manuscripts were included. The search was conducted in July 2020. Patients: Adult outpatient populations with CKD, using any recognized diagnostic criteria. Measurements: The primary outcome was change in glomerular filtration rate (GFR) from baseline through the end of the trial in patients not on dialysis; secondary outcomes included change in uremic toxin concentrations (p-cresol/p-cresyl sulfate [p-CS], indoxyl sulfate [IS]) and inflammatory markers (tumor necrosis factor alpha [TNF-α], C-reactive protein [CRP], interleukin 6 [IL-6]) from baseline through the end of the trial, and changes in self-reported symptom scores. Methods: The Cochrane Collaboration Risk of Bias tool was used to assess risk of bias in included studies. The systematic review results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results: We identified 4 unique studies, reported in 9 publications that met our inclusion criteria, including a total of 215 enrolled participants. Results were calculated using data from the longest reported follow-up time. The primary outcome of changes in kidney function markers was only studied in 1 trial; this trial reported an increase in creatinine and a decrease in blood urea nitrogen; no changes in GFR were reported. A review of the secondary outcomes showed an overall decline in IS, TNF-α, and IL-6, in RS groups, but with mixed results in p-CS and CRP/high-sensitivity CRP. Safety data showed that RS was well tolerated with no reports of excessive side effects. Limitations: We determined a meta-analysis was not feasible due to clinical heterogeneity between study populations and differences in reported outcomes in the included studies. Conclusion: There is limited and inconsistent evidence on the impact of RS in adult patients with CKD. Further research is needed to determine the safety and efficacy of RS supplementation in this population.

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Section: Discussionmentioning

confidence: 99%

The Effects of Resistant Starch Consumption in Adult Patients With Chronic Kidney Disease: A Systematic Review

Kingra

Curtis

Mollard

et al. 2022

Can J Kidney Health Dis

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“…These SCFAs could promote anti-inflammatory and anti-oxidative actions by limiting neutrophil recruitment, macrophage secretion of pro-inflammatory mediators, and histone deacetylase-induced NF-κB activation while promoting anti-inflammatory interleukin-10 formation by T regulatory cells[ 55 ]. Increased availability of SCFA-producing bacteria or SCFA treatment in clinical studies of patients on hemodialysis patients has resulted in lowering inflammatory markers and ameliorating renal function[ 56 , 57 ]. SCFAs are also helpful in the prevention of MAFLD due to the effects mentioned above, together with hepatic AMP-activated protein kinase (AMPK) activation and glucagon-like peptide 1 receptor (GLP1-R) activation, promotion of satiety, and abrogation of insulin resistance[ 58 ].…”

Section: Pathophysiologic Pathways Linking Mafld With Ckdmentioning

confidence: 99%

Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations

Theofilis¹,

Vordoni²,

Kalaitzidis³

2022

World J Gastroenterol

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The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease (MAFLD) has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases. In this context, MAFLD appears to be tightly linked to incident chronic kidney disease (CKD). This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus, arterial hypertension, obesity, dyslipidemia, and insulin resistance. Moreover, similarities in their molecular pathophysiologic mechanisms can be detected, since inflammation, oxidative stress, fibrosis, and gut dysbiosis are highly prevalent in these pathologic states. At the same time, lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms, such as the PNPLA3 rs738409 G allele polymorphism, which may also propagate renal dysfunction. Concerning their management, available treatment considerations for obesity (bariatric surgery) and novel antidiabetic agents (glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter 2 inhibitors) appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling. Moreover, alternative approaches such as melatonin supplementation, farnesoid X receptor agonists, and gut microbiota modulation may represent attractive options in the future. With a look to the future, additional adequately sized studies are required, focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.

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“…RS supplementation has been most extensively investigated in ESKD patients undergoing haemodialysis. In this patient group, RS2 has been associated with decreased Blood Urea Nitrogen, IL-6, TNF-α and serum creatinine [ 44 , 146 , 147 ] as well as reduced levels of oxidative stress and constipation [ 44 ]. A meta-analysis analysing five RCTs investigating the effects of RS2 on ESKD patients undergoing haemodialysis found that RS supplementation did not impact levels of p -cresol sulfate or indoxyl sulfate [ 146 ].…”

Section: Dietary Fibrementioning

confidence: 99%

“…In this patient group, RS2 has been associated with decreased Blood Urea Nitrogen, IL-6, TNF-α and serum creatinine [ 44 , 146 , 147 ] as well as reduced levels of oxidative stress and constipation [ 44 ]. A meta-analysis analysing five RCTs investigating the effects of RS2 on ESKD patients undergoing haemodialysis found that RS supplementation did not impact levels of p -cresol sulfate or indoxyl sulfate [ 146 ]. As these uremic toxins are both promoters and indicators of altered microbial consortium, it may suggest that RS supplementation is less effective in altering the microbiome composition in later CKD stages.…”

Section: Dietary Fibrementioning

confidence: 99%

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease

et al. 2022

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Diabetes is the leading cause of kidney disease, and as the number of individuals with diabetes increases there is a concomitant increase in the prevalence of diabetic kidney disease (DKD). Diabetes contributes to the development of DKD through a number of pathways, including inflammation, oxidative stress, and the gut-kidney axis, which may be amenable to dietary therapy. Resistant starch (RS) is a dietary fibre that alters the gut microbial consortium, leading to an increase in the microbial production of short chain fatty acids. Evidence from animal and human studies indicate that short chain fatty acids are able to attenuate inflammatory and oxidative stress pathways, which may mitigate the progression of DKD. In this review, we evaluate and summarise the evidence from both preclinical models of DKD and clinical trials that have utilised RS as a dietary therapy to limit the progression of DKD.

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Benefits of resistant starch type 2 for patients with end-stage renal disease under maintenance hemodialysis: a systematic review and meta-analysis

Cited by 12 publications

References 61 publications

The Effects of Resistant Starch Consumption in Adult Patients With Chronic Kidney Disease: A Systematic Review

The Effects of Resistant Starch Consumption in Adult Patients With Chronic Kidney Disease: A Systematic Review

Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations

Resistant Starch as a Dietary Intervention to Limit the Progression of Diabetic Kidney Disease

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