Low-fructose diet lowers blood pressure and inflammation in patients with chronic kidney disease

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 2; pp. 608 - 612
• Main Authors: BRYMORA, Andrzej, FLISINSKI, Mariusz, JOHNSON, Richard J, GOSZKA, Grażyna, STEFANSKA, Anna, MANITIUS, Jacek
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2012
• Subjects: Aged; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Pressure Determination; Cohort Studies; Diet, Carbohydrate-Restricted; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Fructose; Humans; Hypertension - prevention & control; Inflammation - physiopathology; Inflammation - prevention & control; Insulin Resistance - physiology; Intensive care medicine; Kidney Function Tests; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Original; Pilot Projects; Renal failure; Renal Insufficiency, Chronic - diagnosis; Renal Insufficiency, Chronic - diet therapy; Severity of Illness Index; Treatment Outcome; Uric Acid - blood; Human; Kidney disease; Extrarenal dialysis; chronic kidney disease; Urinary system disease; Hemodialysis; Renal failure; Arterial pressure; low-fructose diet; Inflammation; Blood pressure; Uric acid
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr223

Fructose has been strongly linked with hypertension, hyperuricemia and inflammation in experimental models and humans. However, the effect of low-fructose diet on inflammation, hyperuricemia and the progression of renal disease has not yet been evaluated in patients with chronic kidney disease (CKD). Twenty-eight patients (age 59 ± 15 years, 17 males/11 females) with Stages 2 and 3 CKD were switched from a regular (basal) (60.0 g/24 h) to a low (12.0 g/24 h) fructose diet for 6 weeks, followed by a resumption of their regular diet for another 6 weeks. Diet was monitored by a dietician. At the baseline, low- and regular-fructose diet ambulatory blood pressure (BP) was measured and blood sampled for renal function (creatinine), inflammatory markers, fasting glucose and insulin and serum uric acid. Twenty-four-hour urine collections were also obtained for creatinine, uric acid, monocyte chemotatic protein-1, transforming growth factor-beta and N-acetyl-beta-D-glucosaminidase. The low-fructose diet tended to improve BP for the whole group (n = 28), while significant reduction of BP was only seen in dippers (n = 20) but not in non-dippers (n = 8). No effects on estimated glomerular filtration rate (eGFR) or proteinuria were observed. Serum uric acid was lowered non-significantly with low-fructose diet (7.1 ± 1.3 versus 6.6 ± 1.0 mg/dL, P < 0.1), whereas a significant decrease in fasting serum insulin was observed (11.2 ± 6.1 versus 8.2 ± 2.9 mIU/mL, P < 0.05) and the reduction persisted after return to the regular diet. A slight but not significant reduction in urinary uric acid and fractional uric acid excretion was observed while the patients were on the low fructose diet. The low-fructose diet also decreased high sensitivity C-reactive protein (hsCRP) (4.3 ± 4.9 versus 3.3 ± 4.5 mg/L; P < 0.01) and soluble intercellular adhesion molecule (sICAM) (250.9 ± 59.4 versus 227 ± 50.5 ng/mL; P < 0.05). The hsCRP returned to baseline with resumption of the regular diet, whereas the reduction in sICAM persisted. Low-fructose diet in subjects with CKD can reduce inflammation with some potential benefits on BP. This pilot study needs to be confirmed by a larger clinical trial to determine the long-term benefit of a low-fructose diet compared to other diets in subjects with CKD.