Abstract
Gut dysbiosis in patients with chronic kidney disease (CKD) may induce chronic inflammation and increase morbidity. Phosphate-binding agents, generally used in patients with CKD, may potentially change the composition of the gut microbiota. This study aimed to compare the microbiota composition in hemodialysis patients treated with ferric citrate or calcium carbonate. The stool microbiota was investigated in hemodialysis patients treated with ferric citrate (n = 8) and calcium carbonate (n = 46) using 16S rRNA gene amplicon sequencing profiling using linear discriminant analysis of effect size. Further predictive functional profiling of microbial communities was obtained with Tax4Fun in R. Hemodialysis patients treated with calcium carbonate had a significantly reduced microbial species diversity (Shannon index and Simpson index) and an increased microbial alteration ratio compared with patients treated with ferric citrate. A distinct microbial community structure was found in patients treated with ferric citrate, with an increased abundance of the Bacteroidetes phylum and a decreased abundance of the phylum Firmicutes. Members of the order Lactobacillales were enriched in patients treated with calcium carbonate, whereas taxa of the genera Ruminococcaceae UCG-004, Flavonifractor, and Cronobacter were enriched in patients treated with ferric citrate phosphate binder. In conclusion, Ferric citrate therapy results in a more diverse microbiome community compared to calcium carbonate therapy in hemodialysis patients with phosphate binder treatment. The gut microbiome reflects the phosphate binder choice in hemodialysis patients, further affecting the physiological environment in the gastrointestinal tract.
Highlights
Patients with chronic kidney disease (CKD) are often treated with oral phosphate binders such as iron or calcium-containing phosphate binders to control hyperphosphatemia [1]
The distinctiveness of the microbiota was confirmed by β diversity analysis (Bray-Curtis dissimilarity metrics), demonstrating the clustering of samples according to two different phosphate binders, with the microbial communities in both groups containing higher levels of Bacteroidetes and lower levels of Firmicutes, similar to the microbial communities identified in rats with CKD [5]
In terms of the stool microbiota composition, calcium carbonate users had more bacteria from order Bacilli to species Streptococcus salivarius; genus Streptococcus was enriched in calcium carbonate users, while the genus Ruminococcaceae UCG-004, Flavonifractor, and Cronobacter were enriched in ferric citrate users
Summary
Patients with chronic kidney disease (CKD) are often treated with oral phosphate binders such as iron or calcium-containing phosphate binders to control hyperphosphatemia [1]. The influence of iron and calcium-containing phosphate binders on the gut microbiome is still unknown. An increased microbiome diversity was observed after ferric citrate treatment in a CKD animal model. Ferric citrate treatment increased levels of tryptophanase-possessing bacteria (Verrucomicrobia, Clostridiaceae, and Enterobacteriaceae) [5]. As the gut microbiota of rats and humans are different, the impact of ferric citrate therapy in hemodialysis (HD) patients warrants further investigation. This study aimed to explore and compare the biodiversity and composition of the gut microbiome communities in HD patients with two different phosphate binders treatment (ferric citrate versus calcium carbonate). The study findings could potentially contribute to integrating personalized medicine in phosphate binder treatment
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
