Christiane Ishikawa Ramos1, Rachel Gatti Armani2, Maria Eugenia Canziani2, Carla Juliana Ribeiro Dolenga3, Lia Sumie Nakao3, Katrina Louise Campbell4, Lilian Cuppari5. 1. Nutrition Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil. 2. Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil; Division of Nephrology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. 3. Department of Basic Pathology, Universidade Federal do Paraná (UFPR), Curitiba, Brazil. 4. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia. 5. Nutrition Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil; Division of Nephrology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Electronic address: lcuppari@uol.com.br.
Abstract
OBJECTIVE: The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). DESIGN AND METHODS: This is a cross-sectional analysis including 43 nondiabetic NDD-CKD patients (58% men; 59.0 ± 13.5 years; estimated glomerular filtration rate, 21.3 ± 7.9 mL/min/1.73 m2). Bowel habit was assessed by the Bristol Stool Scale (BSS <3, characterized by hard consistency of stools and/or low frequency of evacuation and BSS ≥3, representing a more regular bowel habit) and by the Rome III criteria. PCS and IS (serum, free and total; urinary, total) were determined by high-performance liquid chromatography. Dietary intake was assessed by the 3-day food records. RESULTS: The frequency of constipation assessed by BSS and Rome III criteria was 33% (n = 14/43) and 35% (n = 15/43), respectively. The BSS <3 exhibited higher PCS, independent of renal function and dietary protein-fiber ratio (β [95% confidence interval {CI}]: serum, total PCS = 1.54 [1.06-2.23], P = .02; serum free PCS = 1.40 [1.00-1.97], P = .05; urinary PCS = 1.78 [1.10-2.90], P < .02). According to the Rome III criteria, a tendency for a higher serum total PCS (β [95% CI]: 1.39 [0.95-2.03 μmol/L], P = .09) and a significantly higher urinary PCS (β [95% CI]: 1.80 [1.11-2.94 μmol/24 h], P = .02) was found in constipated participants. No effect of a compromised bowel habit (Rome III criteria or BSS) was found on IS. CONCLUSION: Constipation may lead to production of PCS in nondiabetic NDD-CKD patients.
OBJECTIVE: The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). DESIGN AND METHODS: This is a cross-sectional analysis including 43 nondiabetic NDD-CKDpatients (58% men; 59.0 ± 13.5 years; estimated glomerular filtration rate, 21.3 ± 7.9 mL/min/1.73 m2). Bowel habit was assessed by the Bristol Stool Scale (BSS <3, characterized by hard consistency of stools and/or low frequency of evacuation and BSS ≥3, representing a more regular bowel habit) and by the Rome III criteria. PCS and IS (serum, free and total; urinary, total) were determined by high-performance liquid chromatography. Dietary intake was assessed by the 3-day food records. RESULTS: The frequency of constipation assessed by BSS and Rome III criteria was 33% (n = 14/43) and 35% (n = 15/43), respectively. The BSS <3 exhibited higher PCS, independent of renal function and dietary protein-fiber ratio (β [95% confidence interval {CI}]: serum, total PCS = 1.54 [1.06-2.23], P = .02; serum free PCS = 1.40 [1.00-1.97], P = .05; urinary PCS = 1.78 [1.10-2.90], P < .02). According to the Rome III criteria, a tendency for a higher serum total PCS (β [95% CI]: 1.39 [0.95-2.03 μmol/L], P = .09) and a significantly higher urinary PCS (β [95% CI]: 1.80 [1.11-2.94 μmol/24 h], P = .02) was found in constipatedparticipants. No effect of a compromised bowel habit (Rome III criteria or BSS) was found on IS. CONCLUSION:Constipation may lead to production of PCS in nondiabetic NDD-CKDpatients.
Authors: Jakub Ruszkowski; Zbigniew Heleniak; Ewa Król; Agnieszka Tarasewicz; Joanna Gałgowska; Jacek M Witkowski; Alicja Dębska-Ślizień Journal: Int J Med Sci Date: 2020-10-18 Impact factor: 3.738
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