Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis

Abstract

Chronic kidney disease (CKD) affects 9.1% of the population worldwide. CKD may lead to structural and functional gastrointestinal alterations, including impairment in the intestinal barrier, digestion and absorption of nutrients, motility, and changes to the gut microbiome. These changes can lead to increased gastrointestinal symptoms in people with CKD, even in early grades of kidney dysfunction. Gastrointestinal symptoms have been associated with lower quality of life and reduced nutritional status. Therefore, there has been considerable interest in improving gastrointestinal health in this clinical population. Gastrointestinal health can be influenced by lifestyle and medications, particularly in advanced grades of kidney dysfunction. Therapies focused on gastrointestinal health have been studied, including the use of probiotics, prebiotics, and synbiotics, yielding limited and conflicting results. This review summarizes the alterations in the gastrointestinal tract structure and function and provides an overview of potential nutritional interventions that kidney disease professionals can provide to improve gastrointestinal health in individuals with CKD.

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

“…In later stages of DKD progression, patients are advised to limit their consumption of the electrolytes potassium and phosphorous [ 65 ] which can be found in fibre rich foods such as fruit, vegetables and wholegrains. Therefore, limiting these nutrients may lead to a diet deficient in fibre [ 41 ], which is indicated by the average fibre intake of CKD patients being significantly below the daily recommended targets [ 65 , 66 ]. Low dietary fibre intake is associated with a decrease in SCFA-producing bacteria, as fibre is their main fuel source [ 66 ].…”

“…Therefore, limiting these nutrients may lead to a diet deficient in fibre [ 41 ], which is indicated by the average fibre intake of CKD patients being significantly below the daily recommended targets [ 65 , 66 ]. Low dietary fibre intake is associated with a decrease in SCFA-producing bacteria, as fibre is their main fuel source [ 66 ].…”

“…The intestinal barrier acts as both a chemical and physical barrier to separate the contents of the colon from that of the bloodstream [ 66 ]. It is maintained through epithelial tight junctions with an overlying mucous layer composed of mucins [ 16 ].…”

“…Additionally, the gut microbiome changes observed in DKD are associated with a decline in intestinal barrier integrity [ 16 ]. A decrease in SCFA-producing bacteria leads to decreased butyrate production, an SCFA which promotes the intestinal barrier [ 43 ], and increased urease positive bacteria promote ammonia production which degrades the intestinal epithelium [ 66 ]. Additionally, urea is directly toxic to the intestinal barrier as it weakens epithelial tight junctions [ 60 , 71 ].…”

Home-delivered meals as an adjuvant to improve volume overload and clinical outcomes in hemodialysis

“…These meals can also be formulated to provide both consistent and adequate energy and protein intake to promote reductions in protein-energy wasting. Similarly, the meals can be formulated to contain adequate amounts of dietary fiber from plant-based foods, which may be beneficial for the gastrointestinal microbiota, leading to lower production of microbially derived uremic toxins [ 85 , 86 ]. Diabetes- and heart-healthy options may be available for patients with these comorbidities.…”