Diet, gut microbiome and indoxyl sulphate in chronic kidney disease patients

Abstract

Emerging evidence suggests that intestinal dysbiosis plays an important role in host inflammation locally and systemically. Such pathological condition is even more prevailing in patients with chronic kidney disease (CKD). Of note, indoxyl sulphate (IS), a gut‐derived uremic toxin, is notorious for its pro‐inflammatory feature in CKD patients. IS accumulates in the body as the urinary excretion of uremic toxins is impaired, and further worsens the kidney function in a vicious cycle to CKD. Dietary restriction in vegetables, fruits and yogurt leads to the predominance of indole‐producing intestinal microbial flora and further exaggerates the accumulation of IS in CKD patients. Recently, interventional studies have shown that circulating IS can be reduced by dietary prebiotic and/or probiotic supplements. However, further randomized controlled trials are warranted to examine whether such beneficial effect of dietary prebiotic/probiotic supplements could be extrapolated to better hard outcomes in CKD population. In this review, we would also like to emphasize the importance of achieving sufficient intake of dietary fibre by proper vegetable pre‐treatment and accurate fruit selection, instead of directly avoiding these potassium‐rich yet fibre‐rich and base‐producing foods.

Docosahexaenoate-enriched fish oil and medium chain triglycerides shape the feline plasma lipidome and synergistically decrease circulating gut microbiome-derived putrefactive postbiotics

“…These classes of postbiotics are derived from the putrefaction of aromatic amino acids that originated from undigested protein having undergone microbial proteolysis in the large intestine [12]. With many of these metabolites considered to be uremic toxins that are correlated with the progression of renal failure, this combination of FO+MCT may provide a renal-protective effect [13]. To our knowledge, the observation that a combination of FO and MCT synergistically decrease circulating putrefactive postbiotics has not been previously published.…”

“…Often these microbial postbiotics are conjugated to sulfate by the intestinal epithelium or liver during reabsorption. Postbiotics derived from microbial putrefaction of amino acids can have deleterious consequences to host health, particularly as risk factors for inflammation and renal disease [13].…”

Dietary Fiber and Gut Microbiota in Renal Diets

“…Bioavailability of potassium and phosphorus in fruits, vegetables and whole grains is lower when compared to processed food [52].To reach sufficient amount of dietary fiber and to ensure a low potassium content in diet for patients with advanced CKD, vegetable should be cooked by boiling in water before ingestion and the fruit should be properly selected. [36,53].…”

A network-based data-mining approach to investigate indole-related microbiota-host co-metabolism

“…Another indole, indole-3-propionate, is involved in inflammatory mechanisms and in the maintenance of intestinal barrier integrity (Venkatesh, Mukherjee et al 2014). The production of indoles depends on gut bacterial action, and therefore is affected by microbiome interventions such as the use of antibiotics (Sun, Schnackenberg et al 2013) or functional foods (Yang and Tarng 2018). A number of bacterial species involved in different indole synthesis pathways have been described in the literature.…”