The Accumulation of Gut Microbiome–derived Indoxyl Sulfate and P-Cresyl Sulfate in Patients With End-stage Renal Disease

The Gut-Peritoneum Axis in Peritoneal Dialysis and Peritoneal Fibrosis

“…Similar to the general CKD population, an increased relative abundance of indole-producing and p -cresol–producing bacteria in the gut was strongly associated with high-serum IS and pCS concentrations in patients receiving PD. 58 However, the study showed that the greatly increased IS and pCS serum concentrations were mainly associated with a significant decrease in their daily urine and dialysate excretion rates. 58 These results are consistent with a previous report that RKF remains responsible for >75% of total pCS and IS clearance in patients treated with PD after 2 years of dialysis.…”

“… 58 However, the study showed that the greatly increased IS and pCS serum concentrations were mainly associated with a significant decrease in their daily urine and dialysate excretion rates. 58 These results are consistent with a previous report that RKF remains responsible for >75% of total pCS and IS clearance in patients treated with PD after 2 years of dialysis. 59 Bao et al 60 recently confirmed the partial dependence of serum concentrations of pCS on RKF in patients treated with PD, associating high-serum pCS concentrations with increased abundances of p -cresol–producing bacteria rather than decreased RKF.…”

Sweet, bloody consumption – what we eat and how it affects vascular ageing, the BBB and kidney health in CKD

“… 60 , 95 After being produced by intestinal bacteria like E.coli , lactobacilli or Bacteroides fragilis , indole is absorbed into the portal circulation and transported to the liver where indole undergoes hydroxylation mediated by cytochrome P450 2E1 (CYP2E1) resulting in the formation of 3-hydroxy indole. 96 , 97 Following hydroxylation, indole is further metabolized by sulfotransferase 1A1 (SULT1A1), which catalyzes the sulfation of indole to produce IS. IS is involved in the pathophysiology of cardiovascular complications and has not only been linked to CKD fibrosis progression but also to changes in bone-mineral metabolism, insulin resistance and development of anemia.…”

Functional Nutrition, Naturopathic Nutrition, and Integrative and Holistic Renal Nutrition in Kidney Health and Value-Based Kidney Care Models

“…Other articles of this issue of the journal include the study by Lu et al, 33 who examined malnutrition risk and kidney function decline in 786 community-dwelling older adults in Singapore; Sa Martins et al, 34 who examined the prognostic value of the Malnutrition-Inflammation Score or Kalantar Score in hospitalization and mortality in 2,444 long-term hemodialysis patients from 25 centers in Portugal with a median period of 45-month follow-up; Lin et al, 35 who conducted a case-controlled study in 11 patients with ESRD and 11 healthy volunteers to study the accumulation of gut microbiome-derived Indoxyl Sulfate and P-Cresyl Sulfate in ESRD; Liao et al, 36 who reports an association between iron deficiency and platelet count elevation in 1,167 dialysis-dependent patients in China; Chen et al, 37 who report their prospective pilot study of the efficacy of roxadustat for erythropoietin hypo-responsiveness in 50 patients on peritoneal dialysis; Yang et al, 38 In conclusion, functional nutrition is an important intercept of precision nutrition and culinary medicine in kidney care and is based on use of functional foods to compliment conventional management strategies in the form of multi-modal, integrative, and holistic nutrition and pharmacotherapy. 6 Functional nutrition can be effectively implemented by trained renal dietitians and other RDNs to manage kidney health and to prevent or correct protein-energy wasting, 40 while it can be integrated into the World Kidney Recipes 10,41 and help enhance education and health literacy in kidney patients and their care-partners.…”