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

Abstract

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.

Association of Trimethylamine, Trimethylamine N-oxide, and Dimethylamine with Cardiovascular Risk in Children with Chronic Kidney Disease

“…Thus, whether these microbes play a crucial role on the development of hypertension via mediating the TMA−TMAO metabolic pathway in children with early-stage CKD deserves further clarification. Of note is that a key factor in determining gut microbiota composition is the type of diet in patients with CKD [46]. Since the Mediterranean diet that is rich in fiber has been proven to reduce cardiovascular risk [47], it can be speculated that high-fiber dietary intervention might be an efficient way to control microbiota to further prevent CVD in CKD children [48,49].…”

Inflammation and Oxidative Stress in Chronic Kidney Disease—Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites

“…In fact, increased urea levels in patients with CKD and favorable alteration of the gut microbiome can lead to an increase in permeability and alterations of the intestinal epithelial barrier [92]. For this reason, it is necessary to preserve the quality of the gut microbiome through the diet; namely by introducing the right amount of protein and fiber [184]. It has also been observed that a VLPD diet reduced PCS levels by about 30-35% in CKD patients after only one week of dietetic treatment [94].…”

Impact of Altered Intestinal Microbiota on Chronic Kidney Disease Progression

“…The range of potential intervention spans from diet modification to population-level education efforts regarding the potential impact of food supplements to reducing uremic toxin generation rate and intestinal absorption, modifying the microbiome or design of interventions to limit toxin actions, such as targeting the AhR [ 9 , 136 , 137 ]. A detailed discussion of modulation of uremic toxins is provided by Koppe et al in this issue [ 138 ]. In this regard, some drugs successfully tested preclinically in culture or in vivo, are already in clinical use, although sometimes for a different indication.…”