Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients?

Black, Ana Paula; Anjos, Juliana Saraiva dos; Cardozo, Ludmila F M F; Carmo, Flávia Lima do; Dolenga, Carla Juliana Ribeiro; Nakao, Lia S.; Ferreira, Dennis de Carvalho; Rosado, Alexandre Soares; Eduardo, José; Mafra, Denise

doi:10.1053/j.jrn.2017.11.007

Cited by 71 publications

(54 citation statements)

References 46 publications

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“…Evidence from a crossover trial of postmenopausal women suggests that replacing meat with soy results in improved insulin sensitivity [44]. In persons with CKD stages: 3-5, soy-based diets have been used as prototypes for low protein diets, documenting improved gut microbial profile [45,46]. Single nutrients commonly rich in plant-based diets have been associated inversely with measures of systemic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease

González-Ortiz

Avesani

et al. 2020

J Nephrol

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Background In persons with CKD, adherence to plant-based diets is associated with lower risk of CKD progression and death, but underlying mechanisms are poorly characterized. We here explore associations between adherence to plant-based diets and measures of insulin sensitivity and inflammation in men with CKD stages 3–5. Methods Cross-sectional study including 418 men free from diabetes, aged 70–71 years and with cystatin-C estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 and not receiving kidney-specific dietetic advice. Information from 7-day food records was used to evaluate the adherence to a plant-based diet index (PBDi), which scores positively the intake of plant-foods and negatively animal-foods. Insulin sensitivity and glucose disposal rate were assessed with the gold-standard hyperinsulinemic euglycemic glucose clamp technique. Inflammation was evaluated by serum concentrations of C-reactive protein (CRP) and interleukin (IL)-6. Associations were explored through linear regression and restricted cubic splines. Results The majority of men had CKD stage 3a. Hypertension and cardiovascular disease were the most common comorbidities. The median PBDi was 38 (range 14–55). Across higher quintiles of PBDi (i.e. higher adherence), participants were less often smokers, consumed less alcohol, had lower BMI and higher eGFR (P for trend <0.05 for all). Across higher PBDi quintiles, patients exhibited higher insulin sensitivity and lower inflammation (P for trend <0.05). After adjustment for eGFR, lifestyle factors, BMI, comorbidities and energy intake, a higher PBDi score remained associated with higher glucose disposal rate and insulin sensitivity as well as with lower levels of IL-6 and CRP. Conclusion In elderly men with non-dialysis CKD stages 3–5, adherence to a plant-based diet was associated with higher insulin sensitivity and lower inflammation, supporting a possible role of plant-based diets in the prevention of metabolic complications of CKD. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease

González-Ortiz

Avesani

et al. 2020

J Nephrol

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“…Significant reduction in serum levels of p-cresyl sulfate (pCS) and changes of gut microbiota were found in moderate CKD patients receiving 6-month of LPD. However, no clustering of pattern was observed in the gut microbiota of patients consuming LPD or free diet [9]. The implementation of VLPD was associated with a reduced abundance of Proteobacteria and increased level of Blautia, Faecalibacterium and Coprococcus and Roseburia species and the concomitant reduction in serum levels of both indoxyl sulfate (IS) and pCS, compared to those patients receiving free diet [10].…”

Section: Introductionmentioning

confidence: 96%

Compositional and Functional Adaptations of Intestinal Microbiota and Related Metabolites in CKD Patients Receiving Dietary Protein Restriction

Lee

Hsu

et al. 2020

Nutrients

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The relationship between change of gut microbiota and host serum metabolomics associated with low protein diet (LPD) has been unraveled incompletely in CKD patients. Fecal 16S rRNA gene sequencing and serum metabolomics profiling were performed. We reported significant changes in the β-diversity of gut microbiota in CKD patients having LPD (CKD-LPD, n = 16). We identified 19 genera and 12 species with significant differences in their relative abundance among CKD-LPD patients compared to patients receiving normal protein diet (CKD-NPD, n = 27) or non-CKD controls (n = 34), respectively. CKD-LPD had a significant decrease in the abundance of many butyrate-producing bacteria (family Lachnospiraceae and Bacteroidaceae) associated with enrichment of functional module of butanoate metabolism, leading to concomitant reduction in serum levels of SCFA (acetic, heptanoic and nonanoic acid). A secondary bile acid, glyco λ-muricholic acid, was significantly increased in CKD-LPD patients. Serum levels of indoxyl sulfate and p-cresyl sulfate did not differ among groups. The relationship between abundances of microbes and metabolites remained significant in subset of resampling subjects of comparable characteristics. Enrichment of bacterial gene markers related to D-alanine, ketone bodies and glutathione metabolism was noted in CKD-LPD patients. Our analyses reveal signatures and functions of gut microbiota to adapt dietary protein restriction in renal patients.

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“…15,16 (6) There are potentially favorable impacts on the gut microbiome leading to lower generation of uremic toxins such as indoxyl sulfate, p-cresol sulfate, TMAO, and other unfavorable substances. 17 TMAO is not only elevated as a consequence of renal insufficiency but also likely contributes to the progression of CKD and the risk of mortality in patients with CKD. 18 There are other benefits from a higher intake of plant-based protein, such as lowering the likelihood of kidney stones and decreased risk of cardiovascular disease due to higher intake of natural antioxidants including carotenoids, tocopherols, and ascorbic acid.…”

mentioning

confidence: 99%

Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough?

Kalantar-Zadeh

Moore

2019

Journal of Renal Nutrition

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Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients?

Cited by 71 publications

References 46 publications

Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease

Plant-based diets, insulin sensitivity and inflammation in elderly men with chronic kidney disease

Compositional and Functional Adaptations of Intestinal Microbiota and Related Metabolites in CKD Patients Receiving Dietary Protein Restriction

Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough?

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