Patients with chronic kidney disease have abnormal upper gastro‐intestinal tract digestive function: A study of uremic enteropathy

Grant, Claire; Harrison, L.; Hoad, Caroline L.; Marciani, Luca; Gowland, Penny; McIntyre, Christopher W.

doi:10.1111/jgh.13458

Cited by 35 publications

(27 citation statements)

References 28 publications

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“…This study found that the median GTT was 19 minutes, and to our knowledge, this is the first to report that GTT, per PillCam data, is not prolonged in those with CKD or end-stage renal disease. Uremia in CKD has been associated with gastritis, disruption of the microbiome, and dysmotility disorders [15]. A single magnetic resonance imaging (MRI) study found that gastric emptying was 20 minutes longer in 12 patients with CKD Stage 4/5, but that data conflicts with our findings that GTT via PillCam was only six minutes longer among 21 patients in the CKD 4/5 group [15].…”

Section: Discussioncontrasting

confidence: 87%

“…Uremia in CKD has been associated with gastritis, disruption of the microbiome, and dysmotility disorders [15]. A single magnetic resonance imaging (MRI) study found that gastric emptying was 20 minutes longer in 12 patients with CKD Stage 4/5, but that data conflicts with our findings that GTT via PillCam was only six minutes longer among 21 patients in the CKD 4/5 group [15]. We are not aware of other studies reporting GTT results by PillCam data among patients with CKD, and our CKD 4/5 cohort is larger than the MRI study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics

Al-Hillan

Curras-Martin

Carson

et al. 2020

Cureus

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics

Al-Hillan

Curras-Martin

Carson

et al. 2020

Cureus

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“…47 In addition, CKD is associated with prolonged gastric emptying, reduced fasting, and postprandial small bowel water content, indicating abnormal gastrointestinal motility and absorption. 48 Reduced postprandial small bowel water content is correlated with plasma endotoxin level, suggesting that bowel wall edema leads to impaired gut barrier function. 48 Taken together, the current evidence suggests that disruption of gut barrier function in CKD is the major mechanism that allows for the translocation of bacterial fragments to the systemic circulation.…”

Section: Mechanisms Of Bacterial Fragment Translocation In Ckdmentioning

confidence: 99%

Circulating Bacterial Fragments as Cardiovascular Risk Factors in CKD

Szeto

McIntyre

2018

JASN

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Cardiovascular disease (CVD) is a major cause of mortality and morbidity in patients with CKD. In the past decade, intestinal dysbiosis and altered gut epithelial barrier function are increasingly recognized in CKD. Uremic patients have slow intestinal transit time, impaired protein assimilation, and decreased consumption of dietary fiber. The use of multiple medications also may contribute to the proliferation of dysbiotic bacteria, which affect the barrier function of intestinal epithelium. In addition, fluid overload and uremic toxins directly reduce the gut barrier function. The major consequence of these alterations, the translocation of bacterial fragments from bowel lumen to systemic circulation, can lead to diverse biologic effects and probably represents an important nontraditional CVD risk factor in CKD. Among all bacterial fragments, endotoxin is the most well studied. Plasma endotoxin levels are markedly elevated in both patients with CKD and those on dialysis, and are associated with the systemic inflammatory state, accelerated atherosclerosis, and clinical CVD in patients on dialysis. Optimization of BP control and the use of ultrapure dialysate can reduce plasma endotoxin levels, with probable metabolic and cardiovascular benefits. The benefit of synbiotic therapy is not confirmed, although results from animal studies are impressive. The biologic effects and clinical relevance of other bacterial fragments, such as bacterial DNA fragments, are less well defined. Further studies are needed to delineate the pathogenic relation between circulating bacterial fragments and CVD, and to define the role of the plasma bacterial fragment level as a prognostic indicator of CKD.

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“…These factors include low fiber intake due to restricted fruit and vegetable consumption to control serum potassium [83,84], constipation [85][86][87], abnormal digestive function [88], impairment of digestion and absorption of protein [89,90], oral iron supplementation [91], and use of phosphate binders to control serum phosphorus and antibiotics to treat infections [92,93].…”

Section: Gut Microbiota In Ckdmentioning

confidence: 99%

The cross-talk between the kidney and the gut: implications for chronic kidney disease

Andrade

Ramos

Cuppari

2017

Nutrire

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In recent decades, special attention has been given to the potential association between the gut ecosystem and chronic diseases. Several features and complications of chronic kidney disease (CKD) may induce an unbalanced gut environment, leading to unfavorable consequences for a patient's health. The first section of this review is dedicated to a description of some aspects of gut microbiota and intestinal barrier physiology. The following section explores the impact of CKD on the gut ecosystem and intestinal barrier, particularly the association with uremic toxins, inflammation, and immunodeficiency. Finally, the review describes the state of the art of potential therapies with prebiotics, probiotics, and synbiotics employed to modulate the gut environment and to reduce the generation of colon-derived uremic toxins in CKD.

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Patients with chronic kidney disease have abnormal upper gastro‐intestinal tract digestive function: A study of uremic enteropathy

Cited by 35 publications

References 28 publications

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics

Capsule Endoscopy Transit Time to Duodenum: Relation to Patient Demographics

Circulating Bacterial Fragments as Cardiovascular Risk Factors in CKD

The cross-talk between the kidney and the gut: implications for chronic kidney disease

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