Reduced protein bound uraemic toxins in vegetarian kidney failure patients treated by haemodiafiltration

Kandouz, Sakina; Shendi, Ali; Zheng, Yishan; Sandeman, Susan; Davenport, Andrew

doi:10.1111/hdi.12414

Cited by 62 publications

(63 citation statements)

References 33 publications

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“…Patients eating vegetarian diets have been reported to have lower SAF (26), and also lower circulating protein-bound azotemic toxins (27). Patients eating vegetarian diets have been reported to have lower SAF (26), and also lower circulating protein-bound azotemic toxins (27).…”

Section: Discussionmentioning

confidence: 99%

The Effect of On‐Line Hemodiafiltration, Vegetarian Diet, and Urine Volume on Advanced Glycosylation End Products Measured by Changes in Skin Auto‐Fluorescence

Nongnuch

Davenport

2018

Artificial Organs

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Increasing urea clearance by hemodialysis (HD) has not improved patient survival. Hemodiafiltration (HDF) has been reported to reduce cardiovascular mortality. HDF increases middle sized solute clearances. Advanced glycosylation end products (AGEs) are associated with increased cardiovascular mortality. We wished to determine whether HDF reduces AGEs. Skin auto-fluorescence (SAF) measures circulating AGEs deposited in the skin. We compared SAF measurements 12 months apart in high flux HD and HDF patients. At enrollment SAF was not different (HD 3.34 ± 0.71 vs. HDF 3.48 ± 1.05 AU). At seven months after completion of SAF measurement, one hemodiafiltration center returned to hemodialysis, and one hemodialysis center converted to hemodiafiltration. In the 66 patients treated solely by high flux HD, SAF increased (3.36 ± 0.71 to 3.82 ± 0.88 AU, P < 0.001), whereas there was no change for 47 exclusively treated by HDF (3.45 ± 1.13 to 3.44 ± 0.85 AU, P > 0.9). SAF increased in 34 patients switching from HDF to high flux HD (3.52 ± 0.94 vs. 3.88 ± 1.05, P < 0.05), with no significant change for 33 patients converting from high flux HD to HDF (3.32 ± 0.72 to 3.48 ± 1.07 AU, P > 0.3). On multivariate analysis, SAF was associated with older age (β coefficient 0.013, P = 0.002), prescription of insulin (β 0.29, P = 0.016), lanthanum (β 0.36, P = 0.004), and warfarin (β 0.62, P = 0.012), whereas vegetarian diet and > 250 mL/day residual urine volume were negatively associated with SAF (β -0.58, P = 0.002 and β -0.26, P = 0.033 respectively). Residual urine output and vegetarian diet were associated with lower AGE deposition. Whereas SAF increased over time in patients treated with high flux HD, there was no statistical change in SAF in those exclusively treated by HDF.

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Section: Discussionmentioning

confidence: 99%

The Effect of On‐Line Hemodiafiltration, Vegetarian Diet, and Urine Volume on Advanced Glycosylation End Products Measured by Changes in Skin Auto‐Fluorescence

Nongnuch

Davenport

2018

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“…In vegetarian patients undergoing hemodiafiltration (HDF), the levels of indoxyl sulfate (IS) and p cresyl sulfate (PCS) (protein bound toxins that accumulate in CKD) were also demonstrated to be lower [75]. The authors suggested that a vegetarian diet might potentially reduce IS and PCS production by the intestinal microbiome.…”

Section: Other Effectsmentioning

confidence: 99%

Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe

Gluba-Brzózka¹,

Franczyk

Rysz

2017

Nutrients

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Healthy diet is highly important, especially in patients with chronic kidney disease (CKD). Proper nutrition provides the energy to perform everyday activities, prevents infection, builds muscle, and helps to prevent kidney disease from getting worse. However, what does a proper diet mean for a CKD patient? Nutrition requirements differ depending on the level of kidney function and the presence of co-morbid conditions, including hypertension, diabetes, and cardiovascular disease. The diet of CKD patients should help to slow the rate of progression of kidney failure, reduce uremic toxicity, decrease proteinuria, maintain good nutritional status, and lower the risk of kidney disease-related secondary complications (cardiovascular disease, bone disease, and hypertension). It has been suggested that plant proteins may exert beneficial effects on blood pressure, proteinuria, and glomerular filtration rate, as well as results in milder renal tissue damage when compared to animal proteins. The National Kidney Foundation recommends vegetarianism, or part-time vegetarian diet as being beneficial to CKD patients. Their recommendations are supported by the results of studies demonstrating that a plant-based diet may hamper the development or progression of some complications of chronic kidney disease, such as heart disease, protein loss in urine, and the progression of kidney damage. However, there are sparse reports suggesting that a vegan diet is not appropriate for CKD patients and those undergoing dialysis due to the difficulty in consuming enough protein and in maintaining proper potassium and phosphorus levels. Therefore, this review will focus on the problem as to whether vegetarian diet and its modifications are suitable for chronic kidney disease patients.

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“…P-cresylsulphate has similarly been linked to CKD and CVD mortality, although the mechanism is not as well defined [44,45]. Interestingly, it has been noted that vegetarians have lower levels of these nephrotoxic compounds compared with omnivores, in both healthy [46] and CKD populations [47]. Vegetarians tend to have higher fibre intakes [46], which could be metabolized by the colonic microbiota instead of amino acids, leading to a reduction in indoxyl sulphate and p-cresylsulphate.…”

Section: Proteinmentioning

confidence: 99%

Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD?

2017

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Diet is one of the largest modifiable risk factors for chronic kidney disease (CKD)-related death and disability. CKD is largely a progressive disease; however, it is increasingly appreciated that hallmarks of chronic kidney disease such as albuminuria can regress over time. The factors driving albuminuria resolution remain elusive. Since albuminuria is a strong risk factor for GFR loss, modifiable lifestyle factors that lead to an improvement in albuminuria would likely reduce the burden of CKD in high-risk individuals, such as patients with diabetes. Dietary therapy such as protein and sodium restriction has historically been used in the management of CKD. Evidence is emerging to indicate that other nutrients may influence kidney health, either through metabolic or haemodynamic pathways or via the modification of gut homeostasis. This review focuses on the role of diet in the pathogenesis and progression of CKD and discusses the latest findings related to the mechanisms of diet-induced kidney disease. It is possible that optimizing diet quality or restricting dietary intake could be harnessed as an adjunct therapy for CKD prevention or progression in susceptible individuals, thereby reducing the burden of CKD.

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Reduced protein bound uraemic toxins in vegetarian kidney failure patients treated by haemodiafiltration

Cited by 62 publications

References 33 publications

The Effect of On‐Line Hemodiafiltration, Vegetarian Diet, and Urine Volume on Advanced Glycosylation End Products Measured by Changes in Skin Auto‐Fluorescence

The Effect of On‐Line Hemodiafiltration, Vegetarian Diet, and Urine Volume on Advanced Glycosylation End Products Measured by Changes in Skin Auto‐Fluorescence

Vegetarian Diet in Chronic Kidney Disease—A Friend or Foe

Stirring the Pot: Can Dietary Modification Alleviate the Burden of CKD?

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