Abstract
BackgroundIndoxyl sulfate (IS) is produced by action of the intestinal flora on tryptophan in protein diet, and it is normally excreted by the kidney. IS is a protein-bound uremic toxin, and it is difficult to be removed by conventional hemodialysis (HD) methods; so, it accumulates in HD patients and may contribute to major cardiovascular morbidity and mortality.AimTo study the effect of dietary synbiotic (prebiotic and probiotic) supplementation on IS level in prevalent HD patients.Patients and methodsThis single-blind, placebo-controlled trial was conducted on 80 prevalent HD patients (between January 2017 and March 2017) in Ain Shams University Hospital. Patients were divided into 2 groups: group 1 was given synbiotic (SYN) and group 2 was given placebo for 6 weeks. Blood levels of IS, CRP, creatinine, blood urea nitrogen (BUN), sodium, potassium, calcium, and phosphorus were measured at baseline and after 6 weeks.ResultsThere was a significant reduction in serum IS level in groups 1 and 2 in comparison to their baselines (P value = 0.000 and 0.019 respectively); however, the change in IS level in group 1 after SYN supplementation (64% with IR 72.38–33.33) was more than that shown in group 2 (did not receive SYN) (18.47% with IR 26.75–26.75) with a highly significant P value, 0.000. Also, there were significant reductions in the levels of creatinine, BUN, phosphorus (P values < 0.001), and CRP (P values 0.002) in group 1 respectively with no similar changes noticed in group 2.ConclusionSYN supplementation in HD patients can reduce serum levels of IS and other uremic toxins like BUN and creatinine. Also, it may help to reduce serum phosphorus and CRP levels.
Highlights
Indoxyl sulfate (IS) is produced by action of the intestinal flora on tryptophan in protein diet, and it is normally excreted by the kidney
Dysbiosis is associated with abnormal production of uremic toxins which can be corrected by supplementation of specific types of probiotics and prebiotics [7]
This study was conducted on 80 prevalent HD patients recruited from the Ain Shams University Hospital which were divided into 2 groups: group 1 received SYN for 6 weeks, and group 2 received placebo
Summary
Indoxyl sulfate (IS) is produced by action of the intestinal flora on tryptophan in protein diet, and it is normally excreted by the kidney. IS is a protein-bound uremic toxin, and it is difficult to be removed by conventional hemodialysis (HD) methods; so, it accumulates in HD patients and may contribute to major cardiovascular morbidity and mortality. Indoxyl sulfate is a major protein-bound uremic toxin produced by the action of gut microbiota on tryptophan amino acid in dietary protein. Elevated IS levels in chronic kidney disease (CKD) are associated with hazardous effects like progression of CKD [3] cardiovascular disease (CVD) and all-cause mortality in HD patients [4]. In CKD patients, there is an alteration of the normal gut microbiome (dysbiosis) with an increase in aerobic. Dysbiosis is associated with abnormal production of uremic toxins which can be corrected by supplementation of specific types of probiotics and prebiotics [7]
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