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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)

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 =...

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Autores principales: Di Iorio, Biagio Raffaele, Rocchetti, Maria Teresa, De Angelis, Maria, Cosola, Carmela, Marzocco, Stefania, Di Micco, Lucia, di Bari, Ighli, Accetturo, Matteo, Vacca, Mirco, Gobbetti, Marco, Di Iorio, Mattia, Bellasi, Antonio, Gesualdo, Loreto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780815/
https://www.ncbi.nlm.nih.gov/pubmed/31510015
http://dx.doi.org/10.3390/jcm8091424
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author Di Iorio, Biagio Raffaele
Rocchetti, Maria Teresa
De Angelis, Maria
Cosola, Carmela
Marzocco, Stefania
Di Micco, Lucia
di Bari, Ighli
Accetturo, Matteo
Vacca, Mirco
Gobbetti, Marco
Di Iorio, Mattia
Bellasi, Antonio
Gesualdo, Loreto
author_facet Di Iorio, Biagio Raffaele
Rocchetti, Maria Teresa
De Angelis, Maria
Cosola, Carmela
Marzocco, Stefania
Di Micco, Lucia
di Bari, Ighli
Accetturo, Matteo
Vacca, Mirco
Gobbetti, Marco
Di Iorio, Mattia
Bellasi, Antonio
Gesualdo, Loreto
author_sort Di Iorio, Biagio Raffaele
collection PubMed
description 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.
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spelling pubmed-67808152019-10-30 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) Di Iorio, Biagio Raffaele Rocchetti, Maria Teresa De Angelis, Maria Cosola, Carmela Marzocco, Stefania Di Micco, Lucia di Bari, Ighli Accetturo, Matteo Vacca, Mirco Gobbetti, Marco Di Iorio, Mattia Bellasi, Antonio Gesualdo, Loreto J Clin Med Article 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. MDPI 2019-09-10 /pmc/articles/PMC6780815/ /pubmed/31510015 http://dx.doi.org/10.3390/jcm8091424 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Di Iorio, Biagio Raffaele
Rocchetti, Maria Teresa
De Angelis, Maria
Cosola, Carmela
Marzocco, Stefania
Di Micco, Lucia
di Bari, Ighli
Accetturo, Matteo
Vacca, Mirco
Gobbetti, Marco
Di Iorio, Mattia
Bellasi, Antonio
Gesualdo, Loreto
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)
title 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)
title_full 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)
title_fullStr 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)
title_full_unstemmed 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)
title_short 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)
title_sort 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)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780815/
https://www.ncbi.nlm.nih.gov/pubmed/31510015
http://dx.doi.org/10.3390/jcm8091424
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