Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial

Ramos, Christiane Ishikawa; Armani, Rachel Gatti; Canziani, María Eugênia Fernandes; Dalboni, Maria Aparecida; Dolenga, Carla Juliana Ribeiro; Nakao, Lia S.; Campbell, Katrina L.; Cuppari, Lílian

doi:10.1093/ndt/gfy171

Cited by 68 publications

(51 citation statements)

References 38 publications

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“…It is worth mentioning that although our study had a shorter intervention time (4 weeks), the amount of RS administered per day was higher (16 g). In addition, Ramos et al did not observed reduction of IAA after supplementation with a prebiotic (FOS) in pre-dialysis patients, agreeing with our results 33 .…”

Section: Discussionsupporting

confidence: 93%

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Resistant starch supplementation effects on plasma indole 3-acetic acid and aryl hydrocarbon receptor mRNA expression in hemodialysis patients: Randomized, double blind and controlled clinical trial

et al. 2020

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Introduction: Gut microbiota imbalance is linked to high uremic toxins production such as indole-3-acetic acid (IAA) in chronic kidney disease patients. This toxin can activate the aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor involved with inflammation. Strategies to restore gut microbiota balance can be associated with reduced production of IAA and its deleterious effects. This study aimed to evaluate prebiotic resistant starch (RS) supplementation effects on IAA plasma levels and AhR mRNA expression in CKD patients on hemodialysis (HD). Methods: This randomized, double-blind and placebo-controlled clinical trial evaluated forty-two stable HD patients allocated in RS (n=22) or placebo (n=20) groups. Patients received, alternately, cookies and sachets containing 16 g/day of RS (Hi-Maize 260®) or manioc flour for four weeks. Fasting pre-dialysis blood samples were collected and IAA plasma levels measured by high performance liquid chromatography. Peripheral blood mononuclear cells were isolated and processed for AhR and nuclear factor kappa B (NF-κB) mRNA expression analyzes by quantitative real-time PCR. Anthropometric and biochemical parameters, as well as food intake were also evaluated. Results: Thirty-one patients completed the study, 15 in the RS group and 16 in the placebo group. Although there was no significant alteration in IAA plasma levels, neither in AhR mRNA expression and NF-κB mRNA expression after RS supplementation, a positive correlation (r=0.48; p=0.03) was observed between IAA plasma levels and AhR expression at baseline. Conclusion: Even though prebiotic RS supplementation did not influence IAA levels or AhR expression, their positive association reinforces a possible interaction between them.

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Section: Discussionsupporting

confidence: 93%

“…IAA and uremic toxins relationship have been explored in the CKD 16 , 23 , 32 , 33 . In a clinical trial, IAA was associated with an increase in mortality and cardiovascular events in CKD patients with IAA levels > 3.73 µM when compared to patients with lower levels (IAA <= 3.73 µM).…”

Section: Discussionmentioning

confidence: 99%

Resistant starch supplementation effects on plasma indole 3-acetic acid and aryl hydrocarbon receptor mRNA expression in hemodialysis patients: Randomized, double blind and controlled clinical trial

et al. 2020

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“…In addition, dietary fiber may delay gastric emptying, bind bile acid, compete with dietary protein as substrates for fermentation by the gut flora [41]. In this sense, a recent trial in CKD patients showed that increased fiber intake was similarly effective to pharmacological treatments in the management of constipation, a common complication of CKD [42]. Dietary fiber is also accompanied by increased vitamin intake and antioxidant intake, that can lead to lower endogenous production of acid, and reduced production of uremic toxins such as p-cresyl sulfate and indoxyl sulfate, two considered risk factors for accelerated CKD progression [43].…”

Section: Dietary Fibermentioning

confidence: 99%

Modest U-Shaped Association between Dietary Acid Load and Risk of All-Cause and Cardiovascular Mortality in Adults

Åkesson²,

Orsini³

et al. 2016

The Journal of Nutrition

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“…Consumption of fermentable oligosaccharides by rats led to a decrease in blood urea [ 18 ]. In humans with non-dialysis-dependent CKD, a three-month, randomized, double-blind, placebo-controlled trial showed a reduction in the microbial-derived uremic toxin p-cresyl sulfate with the consumption of fructooligosaccharide [ 19 ]. In addition, a small study in which nine overweight beagles were given inulin-type fructans found changes in metabolites and the gut microbiome [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Added Dietary Betaine and Soluble Fiber on Metabolites and Fecal Microbiome in Dogs with Early Renal Disease

Ephraim¹,

Jewell

2020

Metabolites

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Renal diets are recommended for dogs with chronic kidney disease (CKD). This study examined the effects of foods with added betaine and fiber on the plasma and fecal metabolome and fecal microbiome in dogs with early stage CKD. At baseline, several metabolites differed between healthy dogs and those with CKD. Dogs with CKD (n = 28) received a control food, low soluble fiber plus betaine food (0.5% betaine, 0.39% oat beta-glucan, and 0.27% short-chain fructooligosaccharides (scFOS)), or high soluble fiber plus betaine food (0.5% betaine, 0.59% oat beta-glucan, and 0.41% scFOS) each for 10 weeks in different sequences. Consumption of test foods led to several favorable, significant changes in the plasma metabolome, including decreases of several uremic toxins and other deleterious metabolites, and increases in favorable metabolites compared with the control food. Only 7 fecal metabolites significantly changed with consumption of the test foods compared with the control food, largely increases in polyphenols and lignans. Few changes were seen in the fecal microbiome, though some taxa that significantly changed in response to the test foods have beneficial effects on health, with some negatively correlating with uremic toxins. Overall, foods with added betaine and soluble fiber showed positive effects on the plasma and fecal metabolomes.

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Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial

Abstract: Our result suggests the potential of FOS in reducing serum total and free PCS in nondiabetic NDD-CKD patients.

Cited by 68 publications

References 38 publications

Resistant starch supplementation effects on plasma indole 3-acetic acid and aryl hydrocarbon receptor mRNA expression in hemodialysis patients: Randomized, double blind and controlled clinical trial

Resistant starch supplementation effects on plasma indole 3-acetic acid and aryl hydrocarbon receptor mRNA expression in hemodialysis patients: Randomized, double blind and controlled clinical trial

Modest U-Shaped Association between Dietary Acid Load and Risk of All-Cause and Cardiovascular Mortality in Adults

Effect of Added Dietary Betaine and Soluble Fiber on Metabolites and Fecal Microbiome in Dogs with Early Renal Disease

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