Food-Derived Uremic Toxins in Chronic Kidney Disease

Abstract

Patients with chronic kidney disease (CKD) have a higher cardiovascular risk compared to the average population, and this is partially due to the plasma accumulation of solutes known as uremic toxins. The binding of some solutes to plasma proteins complicates their removal via conventional therapies, e.g., hemodialysis. Protein-bound uremic toxins originate either from endogenous production, diet, microbial metabolism, or the environment. Although the impact of diet on uremic toxicity in CKD is difficult to quantify, nutrient intake plays an important role. Indeed, most uremic toxins are gut-derived compounds. They include Maillard reaction products, hippurates, indoles, phenols, and polyamines, among others. In this review, we summarize the findings concerning foods and dietary components as sources of uremic toxins or their precursors. We then discuss their endogenous metabolism via human enzyme reactions or gut microbial fermentation. Lastly, we present potential dietary strategies found to be efficacious or promising in lowering uremic toxins plasma levels. Aligned with current nutritional guidelines for CKD, a low-protein diet with increased fiber consumption and limited processed foods seems to be an effective treatment against uremic toxins accumulation.

Urine Metabolomic Signature of People Diagnosed with Balkan Endemic Nephropathy and Other Types of Chronic Kidney Disease Compared with Healthy Subjects in Romania

“…Even though hippuric acid is known to exhibit elevated concentration in CKDs [ 31 ], our results showed similar average concentrations in BEN cases and controls. More than 50% of urinary compounds were derivatives of dietary origin: hippurates, indoles, phenols, polyamines [ 32 ].…”

Cardiovascular Consequences of Uremic Metabolites: an Overview of the Involved Signaling Pathways

“…84,237 Nonetheless, the trajectory of contemporary research has discerned discrete molecular targets intricately implicated in the genesis and downstream effects of these toxins. [238][239][240] The impetus behind novel pharmacological approaches resides in the strategic inhibition of uremic toxin production before kidney failure develops or in the augmentation of their efficacious elimination. [241][242][243] Recent research has identified molecular targets such as the gut microbiome 54,244 involved in the generation and effects of uremic toxins, for example, IS, 245,246 TMAO, 247 and p-cresol/PCS.…”

Cognitive disorders in patients with chronic kidney disease: Approaches to prevention and treatment

“…Although several nonpharmacological approaches are available, it is unfortunate that very few studies have focused on or reported on cognitive outcomes in patients with CKD. Further research is needed to evaluate the potential benefits of nonpharmacological interventions, such as healthy diet (i.e., Mediterranean diet) [91] and dietary interventions like low‐protein diets, on gut‐derived uremic toxins in CKD patients [92].…”

“…interventions, such as healthy diet (i.e., Mediterranean diet)[91] and dietary interventions like low-protein diets, on gut-derived uremic toxins in CKD patients[92].…”