scholarly journals Ketoanalogs’ Effects on Intestinal Microbiota Modulation and Uremic Toxins Serum Levels in Chronic Kidney Disease (Medika2 Study)

2021 ◽  
Vol 10 (4) ◽  
pp. 840
Author(s):  
Maria Teresa Rocchetti ◽  
Biagio Raffaele Di Iorio ◽  
Mirco Vacca ◽  
Carmela Cosola ◽  
Stefania Marzocco ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Therapeutic Option ◽  
Specific Effect ◽  
Serum Levels ◽  
Nutritional Therapy ◽  
Low Protein ◽  
Diet Regimen

Nutritional therapy (NT) is a therapeutic option in the conservative treatment of chronic kidney disease (CKD) patients to delay the start of dialysis. The aim of this study was to evaluate the specific effect of ketoanalogs (KA)-supplemented diets for gut microbiota modulation. In a previous study we observed that the Mediterranean diet (MD) and a KA-supplemented very-low-protein diet (VLPD) modulated beneficially gut microbiota, reducing indoxyl- and p-cresyl-sulfate (IS, PCS) serum levels, and ameliorating the intestinal permeability in CKD patients. In the current study, we added a third diet regimen consisting of KA-supplemented MD. Forty-three patients with CKD grades 3B–4 continuing the crossover clinical trial were assigned to six months of KA-supplemented MD (MD + KA). Compared to MD, KA-supplementation in MD + KA determined (i) a decrease of Clostridiaceae, Methanobacteriaceae, Prevotellaceae, and Lactobacillaceae while Bacteroidaceae and Lachnospiraceae increased; (ii) a reduction of total and free IS and PCS compared to a free diet (FD)—more than the MD, but not as effectively as the VLPD. These results further clarify the driving role of urea levels in regulating gut integrity status and demonstrating that the reduction of azotemia produced by KA-supplemented VLPD was more effective than KA-supplemented MD in gut microbiota modulation mainly due to the effect of the drastic reduction of protein intake rather than the effect of KA.

scholarly journals Nutritional Therapy Modulates Intestinal Microbiota and Reduces Serum Levels of Total and Free Indoxyl Sulfate and P-Cresyl Sulfate in Chronic Kidney Disease (Medika Study)

2019 ◽  
Vol 8 (9) ◽  
pp. 1424 ◽  
Author(s):  
Biagio Raffaele Di Iorio ◽  
Maria Teresa Rocchetti ◽  
Maria De Angelis ◽  
Carmela Cosola ◽  
Stefania Marzocco ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Binding Capacity ◽  
Controlled Trial ◽  
Serum Levels ◽  
Nutritional Therapy ◽  
Indoxyl Sulfate ◽  
Lower Amount ◽  
Dietary Intakes

In chronic kidney disease (CKD), the gut-microbiota metabolites indoxyl sulfate (IS) and p-cresyl sulfate (PCS) progressively accumulate due to their high albumin-binding capacity, leading to clinical complications. In a prospective crossover controlled trial, 60 patients with CKD grades 3B–4 (GFR = 21.6 ± 13.2 mL/min) were randomly assigned to two dietary regimens: (i) 3 months of free diet (FD) (FD is the diet usually used by the patient before being enrolled in the Medika study), 6 months of very low protein diet (VLPD), 3 months of FD and 6 months of Mediterranean diet (MD); (ii) 3 months of FD, 6 months of MD, 3 months of FD, and 6 months of VLPD. VLPD reduced inflammatory Proteobacteria and increased Actinobacteria phyla. MD and VLPD increased some butyrate-forming species of Lachnospiraceae, Ruminococcaceae, Prevotellaceae, Bifidobacteriaceae, and decrease the pathobionts Enterobacteriaceae. The increased level of potential anti-inflammatory Blautia and Faecalibacterium, as well as butyrate-forming Coprococcus and Roseburia species in VLPD was positively associated with dietary intakes and it was negatively correlated with IS and PCS. Compared to FD and MD, VLPD showed a lower amount of some Lactobacillus, Akkermansia, Streptococcus, and Escherichia species. MD and VLPD reduced both the total and free serum IS (MD −36%, −40% and VLPD −69%, −73%, respectively) and PCS (MD −38%, −44% and VLPD −58%, −71%, respectively) compared to FD. VLPD reduced serum D-lactate compared to MD and FD. MD and, to a greater extent, VLPD are effective in the beneficial modulation of gut microbiota, reducing IS and PCS serum levels, and restoring intestinal permeability in CKD patients.

Does Low-Protein Diet Influence the Uremic Toxin Serum Levels From the Gut Microbiota in Nondialysis Chronic Kidney Disease Patients?

2018 ◽  
Vol 28 (3) ◽  
pp. 208-214 ◽  
Author(s):  
Ana Paula Black ◽  
Juliana S. Anjos ◽  
Ludmila Cardozo ◽  
Flávia L. Carmo ◽  
Carla J. Dolenga ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota ◽  
Serum Levels ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Uremic Toxin ◽  
Low Protein

scholarly journals Alteration of circadian machinery in monocytes underlies chronic kidney disease-associated cardiac inflammation and fibrosis

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Yuya Yoshida ◽  
Naoya Matsunaga ◽  
Takaharu Nakao ◽  
Kengo Hamamura ◽  
Hideaki Kondo ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clock Genes ◽  
Serum Levels ◽  
Serum Retinol ◽  
Cardiac Inflammation ◽  
Physiological Processes ◽  
G Protein Coupled ◽  
Clock Protein

AbstractDysfunction of the circadian clock has been implicated in the pathogenesis of cardiovascular disease. The CLOCK protein is a core molecular component of the circadian oscillator, so that mice with a mutated Clock gene (Clk/Clk) exhibit abnormal rhythms in numerous physiological processes. However, here we report that chronic kidney disease (CKD)-induced cardiac inflammation and fibrosis are attenuated in Clk/Clk mice even though they have high blood pressure and increased serum angiotensin II levels. A search for the underlying cause of the attenuation of heart disorder in Clk/Clk mice with 5/6 nephrectomy (5/6Nx) led to identification of the monocytic expression of G protein-coupled receptor 68 (GPR68) as a risk factor of CKD-induced inflammation and fibrosis of heart. 5/6Nx induces the expression of GPR68 in circulating monocytes via altered CLOCK activation by increasing serum levels of retinol and its binding protein (RBP4). The high-GPR68-expressing monocytes have increased potential for producing inflammatory cytokines, and their cardiac infiltration under CKD conditions exacerbates inflammation and fibrosis of heart. Serum retinol and RBP4 levels in CKD patients are also sufficient to induce the expression of GPR68 in human monocytes. Our present study reveals an uncovered role of monocytic clock genes in CKD-induced heart failure.

scholarly journals The Role of Gut Microbiota and Diet on Uremic Retention Solutes Production in the Context of Chronic Kidney Disease

Toxins ◽  
2018 ◽  
Vol 10 (4) ◽  
pp. 155 ◽  
Author(s):  
Laetitia Koppe ◽  
Denis Fouque ◽  
Christophe Soulage
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gut Microbiota

scholarly journals SP400VERY LOW PROTEIN DIET REDUCES SERUM LEVELS OF INDOXYL SULFATE AND P-CRESYL SULFATE IN CHRONIC KIDNEY DISEASE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii253-iii253 ◽  
Author(s):  
Maria Teresa Rocchetti ◽  
Carmela Cosola ◽  
Ighli di Bari ◽  
Lucia Di Micco ◽  
Emanuele De Simone ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Serum Levels ◽  
Indoxyl Sulfate ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein

scholarly journals The Effect of Ketoanalogues on Chronic Kidney Disease Deterioration: A Meta-Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 957 ◽  
Author(s):  
Albert Li ◽  
Hsiang-Yen Lee ◽  
Yen-Chung Lin
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Low Protein ◽  
Randomized Control ◽  
Very Low Protein Diet ◽  
Restricted Protein Diet

The effects of ketoanalogues (KA) on chronic kidney disease (CKD) deterioration have not yet been fully confirmed. To strengthen the evidence of the role of KA in CKD, PubMed and Embase were searched for studies published through February 2019. Effect sizes from ten randomized control trials (RCTs) and two non-RCTs comprising a total of 951 patients were pooled and analyzed. A restricted protein diet supplemented with ketoanalogues (RPKA) was found to significantly delay the progression of CKD (p = 0.008), particularly in patients with an estimated glomerular filtration rate (eGFR) > 18 mL/min/1.73 m2 (p < 0.0001). No significant change in eGFR was found when comparing a very-low-protein diet and a low-protein diet (p = 0.10). In addition, compared with the placebo, RPKA did not cause malnutrition (albumin: p = 0.56; cholesterol: p = 0.50). Moreover, RPKA significantly decreased phosphorous levels (p = 0.001), increased calcium levels (p = 0.04), and decreased parathyroid hormone (PTH) levels (p = 0.05) in patients with eGFR < 18 mL/min/1.73 m2. In conclusion, RPKA could slow down the progression of CKD in patients with eGFR > 18 mL/min/1.73 m2 without causing malnutrition and reverse CKD-MBD in patients with eGFR < 18 mL/min/1.73 m2.

scholarly journals Very Low Protein Diet for Patients with Chronic Kidney Disease: Recent Insights

2019 ◽  
Vol 8 (5) ◽  
pp. 718 ◽  
Author(s):  
Lucia Di Micco ◽  
Luca Di Lullo ◽  
Antonio Bellasi ◽  
Biagio R. Di Iorio
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Therapy ◽  
Sodium Content ◽  
Protein Diet ◽  
Low Protein Diet ◽  
Phosphate Binders ◽  
Beneficial Effects ◽  
Low Protein ◽  
Very Low Protein Diet

Use of nutritional therapy (NT) in chronic kidney disease (CKD) patients is still debated among nephrologists, but it represents a fundamental point in the conservative treatment of CKD. It has been used for years and it has new goals today, such as (1) the reduction of edema, diuretics, and blood pressure values with a low sodium-content diet; (2) the dose reduction of phosphate levels and phosphate binders; (3) the administration of bicarbonate with vegetables in order to correct metabolic acidosis and delay CKD progression; (4) the reduction of the number and the doses of drugs and chemical substances; and (5) the lowering of urea levels, the cure of intestinal microbioma, and the reduction of cyanates levels (such as indoxyl-sulphate and p-cresol sulphate), which are the most recent known advantages achievable with NT. In conclusion, NT and especially very low protein diet (VLPD) have several beneficial effects in CKD patients and slows the progression of CKD.

scholarly journals Nutrition in Chronic Kidney Disease—The Role of Proteins and Specific Diets

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 956
Author(s):  
Mugurel Apetrii ◽  
Daniel Timofte ◽  
Luminita Voroneanu ◽  
Adrian Covic
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Therapy ◽  
Dietary Therapy ◽  
Global Public Health ◽  
Energy Status ◽  
Public Health Burden ◽  
Comprehensive Management ◽  
Protein Energy

Chronic kidney disease (CKD) is a global public health burden, needing comprehensive management for preventing and delaying the progression to advanced CKD. The role of nutritional therapy as a strategy to slow CKD progression and uremia has been recommended for more than a century. Although a consistent body of evidence suggest a benefit of protein restriction therapy, patients’ adherence and compliance have to be considered when prescribing nutritional therapy in advanced CKD patients. Therefore, these prescriptions need to be individualized since some patients may prefer to enjoy their food without restriction, despite knowing the potential importance of dietary therapy in reducing uremic manifestations, maintaining protein-energy status.

scholarly journals Dietary Fiber and Gut Microbiota in Renal Diets

2019 ◽  
Author(s):  
Carla Camerotto ◽  
Adamasco Cupisti ◽  
Claudia D'Alessandro ◽  
Fulvio Muzio ◽  
Maurizio Gallieni
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Gut Microbiota ◽  
Dietary Fiber ◽  
Intestinal Microbiota ◽  
Energy Supply ◽  
Protective Role ◽  
The Relationship

Nutrition is crucial for the management of patients affected by chronic kidney disease to slow down disease progression and to correct symptoms. The mainstay of nutritional approach to renal patients is protein restriction coupled with adequate energy supply to prevent malnutrition. However, other aspects of renal diets, including fiber content, can be beneficial. This paper summarizes the latest literature on the relationship between the type of dietary fiber and prevention and management of CKD, with special attention to intestinal microbiota and the potential protective role of renal diets. A proper amount of fiber should be recommended not only in general population but also in chronic kidney disease patients, to asses an adequate composition and metabolism of intestinal microbiota and to reduce the risks connected with obesity, diabetes and dyslipidemia.

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