Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Vaziri, Nosratola D.

doi:10.2215/cjn.13631215

Cited by 49 publications

(42 citation statements)

References 22 publications

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“…Apart from uraemia, patients with end‐stage renal disease, the final stage of CKD, usually have lower intake of fibre, resulting in a lower production of short chain fatty acids, which helps to maintain normal gut pH . Moreover, redundant gut‐derived ammonia was transported by portal vein to liver, where it is converted to urea, partially indicating the lack of significant reduction in urea of treated groups …”

Section: Discussionmentioning

confidence: 99%

“…Five different probiotic combinations in a rat CKD model were assessed, only two being able to decrease blood urea nitrogen and serum creatinine . Because unfavourable biochemical environment was likely to affect gut microbiota composition of CKD, it was difficult to recover normal microbiota by applying microorganisms . Food intake, another vital factor affecting gut microbiota, was not recorded in most of the included studies.…”

Section: Discussionmentioning

confidence: 99%

“…[40][41][42] Moreover, redundant gut-derived ammonia was transported by portal vein to liver, where it is converted to urea, partially indicating the lack of significant reduction in urea of treated groups. 43 In the previous studies, probiotics competitively limited lipopolysaccharide (LPS) production and enhanced the epithelial barrier to inhibit inflammatory response. On the other hand, urea hydrolysis by specific probiotics-produced urease also could form the quantities of NH 3 /NH 4 OH and further led to an elevation in pH, which influenced the growth of commensal bacteria and promoted the proliferation of aerobic bacteria.…”

Section: Discussionmentioning

confidence: 99%

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Effects of probiotic supplements on the progression of chronic kidney disease: A meta‐analysis

et al. 2019

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Background Chronic kidney disease (CKD) is a worldwide public health problem. Although accumulated data suggested that probiotic supplements played roles in CKD, the results remained controversial. Here, we performed a meta‐analysis to assess the effects of probiotic supplements on the CKD progression. Methods A systematic search was conducted through the PubMed, Embase and Cochrane databases until September 2018. Randomized controlled trials with control receiving placebo, evaluating the effects of probiotic supplements on CKD were included. Results A total of 10 randomized controlled trials in 8 countries were selected. In the meta‐analysis, urea level was significantly reduced in probiotics‐administrated non‐dialysis patients (mean differences (MD) = −30.01; 95% confidence interval (CI) = [−56.78, −3.25]; P = 0.03) while no significant change was found in the dialysis patients receiving probiotics (MD = 0.1; 95% CI = [−9.28, 9.48]; P = 0.98). Probiotic supplements also exhibited no effect on uric acid (MD = −0.43; 95% CI = [−1.19, 0.33]; P = 0.27), C‐reactive protein (MD = −0.48; 95% CI = [−1.29, 0.33]; P = 0.24), creatinine (MD = −0.18; 95% CI = [−0.82, 0.47]; P = 0.59), and estimated glomerular filtration rate (MD = 2.10; 95% CI = [−1.31, 5.52]; P = 0.23) of CKD patients. Conclusion Our results highlighted that probiotic supplements exerted a statistically significant effect on urea levels in non‐dialysis CKD population, while no evidence suggested that probiotics possessed meaningful impacts on the reduction of uric acid, C‐reactive protein, creatinine and estimated glomerular filtration rate preservation of CKD population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effects of probiotic supplements on the progression of chronic kidney disease: A meta‐analysis

et al. 2019

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“…Interestingly, albuminuria was observed to signiicantly increase with synbiotic therapy, which contradicted the reports of a beneicial efect on proteinuria from animal studies using other uraemic toxin-lowering therapies, such as AST-120 [43,44]. Due to the short duration and small participant numbers of synbiotic trials to date, the efects of treatment on patient-level clinical outcomes remain unknown [2].…”

Section: Strategy Intervention Outcomementioning

confidence: 95%

“…Further efects include gut wall oedema, intestinal barrier impairment, translocation of bacteria and endotoxins across the intestinal wall and resultant systemic inlammation [1][2][3]. Gut dysbiosis may in turn lead to the production of various toxins and metabolites that contribute to uraemic toxicity, cardiovascular disease and progressive kidney scarring and failure [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

The Roles of Indoxyl Sulphate and p-Cresyl Sulphate in Patients with Chronic Kidney Disease: A Review of Therapeutic Options

Nataatmadja¹,

Cho²,

Campbell³

et al. 2018

Chronic Kidney Disease - From Pathophysiology to Clinical Improvements

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Indoxyl sulphate (IS) and p-cresyl sulphate (PCS) are products of proteolytic bacterial fermentation by gut microbiota. They accumulate in the sera of patients with chronic kidney disease (CKD) and have been associated with CKD progression and cardiovascular and all-cause mortality. Therapeutic strategies for lowering IS and PCS include increased clearance (enhanced dialysis), gastrointestinal sequestration (oral adsorbents), reduced synthesis (dietary protein restriction, dietary ibre augmentation and pre-, pro-or synbiotics), antioxidants and organic anion transporter modulators. This review will discuss the roles of IS and PCS as therapeutic targets and examine the clinical evidence for diferent treatment options and their efects on CKD and cardiovascular disease risk. We will include our group's research with pre-, pro-and synbiotic interventions to mitigate serum uraemic toxin accumulation and modify cardiovascular and renal risk.Keywords: indoxyl sulphate, p-cresyl sulphate, uraemic toxins, chronic kidney disease, gut microbiome IntroductionThe reciprocal relationship observed between gut microbiota and chronic kidney disease (CKD) has led to the recent recognition of the 'gut-kidney axis'. Patients with CKD, including those with end-stage kidney disease (ESKD), often experience impaired uraemic toxin clearance, salt and water retention, dietary restrictions, anorexia, dysgeusia and malnutrition, © 2018 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.which in turn leads to quantitative and qualitative alterations in gut microbiome composition (gut dysbiosis). Further efects include gut wall oedema, intestinal barrier impairment, translocation of bacteria and endotoxins across the intestinal wall and resultant systemic inlammation [1][2][3]. Gut dysbiosis may in turn lead to the production of various toxins and metabolites that contribute to uraemic toxicity, cardiovascular disease and progressive kidney scarring and failure [4][5][6]. The central role of the gut microbiome in kidney health therefore makes it an appealing therapeutic target in patients with CKD [7,8].Two key nephrovascular toxins produced by proteolytic bacterial fermentation in the gut are indoxyl sulphate (IS) and p-cresyl sulphate (PCS). IS is produced by tryptophan metabolism facilitated by Escherichia coli and Clostridium sporogenes, while PCS is generated by break down of tyrosine and phenylalanine by intestinal anaerobes, such as Clostridium diicile, Faecalibacterium prausnizii, Subdoligranulum and selected strains within the Biidobacterium and Lactobacillus genus [8]. IS and PCS are both solely produced by the gut microbiota [9][10][11][12] and accumulate in the serum of patients with CKD due to both increased intestinal production and reduced glomerular iltration and proximal tubular sec...

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The modulation effects of plant‐derived bioactive ingredients on chronic kidney disease: Focus on the gut–kidney axis

et al. 2023

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Chronic kidney disease (CKD) results mainly from diabetes, hypertension, and glomerulonephritis, which can develop into end-stage renal disease and CKD-related complications, thereby causing high morbidity and mortality. This progression is correlated with pathogenic alterations in the gut microbiota that generate uremic toxins, mainly including indoxyl sulfate, p-cresol sulfate, and trimethylamine-N-oxide. The uremic toxins directly or indirectly induce CKD through oxidative stress, inflammatory response, and subsequently renal fibrosis. However, ongoing developments in CKD therapy still lack nutritional guidelines and new pharmacotherapies with significant effects. In this review, we discuss the modulatory effects of plant-derived bioactive ingredients, such as dietary fiber (oligosaccharides and polysaccharides), polyphenols (e.g., curcumin, anthocyanins, catechins, and resveratrol), and peptides, on gut microbiota and CKD particularly from the view of the gut-kidney axis. We believe that a comprehensive understanding of the underlying mechanisms of CKD is necessary to develop new targeted therapy strategies that will benefit the prevention and treatment of CKD.

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Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Cited by 49 publications

References 22 publications

Effects of probiotic supplements on the progression of chronic kidney disease: A meta‐analysis

Effects of probiotic supplements on the progression of chronic kidney disease: A meta‐analysis

The Roles of Indoxyl Sulphate and p-Cresyl Sulphate in Patients with Chronic Kidney Disease: A Review of Therapeutic Options

The modulation effects of plant‐derived bioactive ingredients on chronic kidney disease: Focus on the gut–kidney axis

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