Protein/Fiber Index Modulates Uremic Toxin Concentrations in Hemodialysis Patients

• Published in: Toxins Vol. 14; no. 9; p. 589
• Main Authors: Ebersolt, Manon, Santana Machado, Tacy, Mallmann, Cecilia, Mc-Kay, Nathalie, Dou, Laetitia, Bouchouareb, Dammar, Brunet, Philippe, Burtey, Stéphane, Sallée, Marion
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.09.2022; MDPI
• Subjects: Cardiovascular disease; chronic kidney disease; Chronic kidney failure; Creatinine; Diet; Diet therapy; Fatty acids; Fermentation; Hemodialysis; Kidney diseases; Kidneys; Life Sciences; Low concentrations; Methods; Microbiota; Microbiota (Symbiotic organisms); Mortality; Multivariate analysis; Phenols; Physiological aspects; Population; Potassium; protein fiber index; Proteins; Questionnaires; Renal function; Sulfates; Toxins; Urea; uremic toxins; Vegetarianism; France; hemodialysis; chronic kidney disease; uremic toxins; protein fiber index
• ISSN: 2072-6651; 2072-6651
• DOI: 10.3390/toxins14090589

Background: Indoxyl sulfate (IS) and p-cresyl sulfate (PCS), two uremic toxins (UTs), are associated with increased mortality in patients with chronic kidney disease (CKD). These toxins are produced by the microbiota from the diet and excreted by the kidney. The purpose of this study was to analyze the effect of diet on IS and PCS concentration in hemodialysis (HD) patients. Methods: We performed a prospective monocentric study using a seven-day diet record and determination of serum IS and PCS levels in HD patients. We tested the association between toxin concentrations and nutritional data. Results: A total of 58/75 patients (77%) completed the diet record. Mean caloric intake was 22 ± 9.2 kcal/kg/day. The protein/fiber index was 4.9 ± 1.8. No correlation between IS or PCS concentration and protein/fiber index was highlighted. In the 18 anuric patients (31%) in whom residual renal function could not affect toxin concentrations, IS and PCS concentrations were negatively correlated with fiber intake and positively correlated with the protein/fiber index. In a multivariate analysis, IS serum concentration was positively associated with the protein/fiber index (p = 0.03). Conclusions: A low protein/fiber index is associated with low concentrations of uremic toxins in anuric HD patients. Diets with an increased fiber intake must be tested to determine whether they reduce PCS and IS serum concentrations.