Dietary strategies for gut-derived protein-bound uremic toxins and cardio-metabolic risk factors in chronic kidney disease: A focus on dietary fibers


MELEKOĞLU E., SAMUR F. G.

CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION, vol.63, no.19, pp.3994-4008, 2023 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 63 Issue: 19
  • Publication Date: 2023
  • Doi Number: 10.1080/10408398.2021.1996331
  • Journal Name: CRITICAL REVIEWS IN FOOD SCIENCE AND NUTRITION
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, PASCAL, Aerospace Database, Agricultural & Environmental Science Database, Aquatic Science & Fisheries Abstracts (ASFA), Biotechnology Research Abstracts, CAB Abstracts, CINAHL, Communication Abstracts, Compendex, EMBASE, Food Science & Technology Abstracts, MEDLINE, Metadex, SportDiscus, Veterinary Science Database, Civil Engineering Abstracts
  • Page Numbers: pp.3994-4008
  • Keywords: Dietary pattern, gut-kidney axis, indoxyl sulfate, microbiota, p-cresol sulfate, prebiotic, P-CRESYL SULFATE, ALL-CAUSE MORTALITY, INDOXYL SULFATE, MEDITERRANEAN DIET, CARDIOVASCULAR-DISEASE, HEMODIALYSIS-PATIENTS, RENAL-FUNCTION, INTESTINAL MICROBIOTA, SERUM CONCENTRATIONS, INSULIN-RESISTANCE
  • Hacettepe University Affiliated: Yes

Abstract

Chronic kidney disease (CKD) is associated with altered composition and function of gut microbiota. The cause of gut dysbiosis in CKD is multifactorial and encompasses the following: uremic state, metabolic acidosis, slow colonic transit, dietary restrictions of plant-based fiber-rich foods, and pharmacological therapies. Dietary restriction of potassium-rich fruits and vegetables, which are common sources of fermentable dietary fibers, inhibits the conversion of dietary fibers to short-chain fatty acids (SCFA), which are the primary nutrient source for the symbiotic gut microbiota. Reduced consumption of fermentable dietary fibers limits the population of SCFA-forming bacteria and causes dysbiosis of gut microbiota. Gut dysbiosis induces colonic fermentation of protein and formation of gut-derived uremic toxins. In this review, we discuss the roles and benefits of dietary fiber on gut-derived protein-bound uremic toxins and plant-based dietary patterns that could be recommended to decrease uremic toxin formation in CKD patients. Recent studies have indicated that dietary fiber supplementation may be useful to decrease gut-derived uremic toxin formation and slow CKD progression. However, research on associations between adherence of healthy dietary patterns and gut-derived uremic toxins formation in patients with CKD is lacking.