Shuiqing He1, Qianqian Xiong1, Chong Tian2, Li Li1, Jing Zhao1, Xuechun Lin1, Xiaolei Guo1, Yuqin He1, Wangqun Liang3, Xuezhi Zuo4, Chenjiang Ying5. 1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China. 2. School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 3. Department of Nephrology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China. 4. Department of Clinical Nutrition, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China. zuo1967@tjh.tjmu.edu.cn. 5. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China. yingcj@hust.edu.cn.
Abstract
PURPOSE: Increased levels of uric acid (UA), which is mainly excreted through the kidneys, are independently associated with higher mortality in end-stage renal disease (ESRD) patients. The uricolysis of gut microbiota plays an important role in extrarenal excretion of UA. This study aimed to examine the effect of inulin-type prebiotics (a type of fermentable dietary fiber) on intestinal microbiota modulation and serum UA levels in ESRD patients. METHODS: Continuous ambulatory peritoneal dialysis (CAPD) patients were recruited to a randomized, double-blind, placebo-controlled crossover trial of 12-week inulin-type prebiotics. Participants were visited before and after treatment with prebiotics or placebo. Serum UA levels, dietary purine intake, serum xanthine oxidase (XO) activity, daily "renal excretion" of UA, and fecal UA degradation capability were measured at each visit. Fecal metagenomic analysis was conducted to assess microbial composition and function. RESULTS: Sixteen participants (mean age = 37 y; 10 men and 6 women) completed the trial, and 64 specimens were analyzed. The average concentration of serum UA decreased by approximately 10% in the prebiotic intervention group in comparison to the placebo group (p = 0.047) without an increase in daily "renal excretion" of UA via urine and dialysate. There were no significant changes in purine intake or activity of XO. Notably, enhanced fecal UA degradation was observed after prebiotic intervention (p = 0.041), and the ratio of Firmicutes/Bacteroidetes, which was positively associated with fecal UA degradation, increased in the prebiotic period (p = 0.032). Furthermore, prebiotics enriched purine-degrading species in the gut microbiota, including unclassified_o_Clostridiales, Clostridium sp. CAG:7, Clostridium sp. FS41, Clostridium citroniae, Anaerostipes caccae, and Clostridium botulinum. CONCLUSIONS: Inulin-type prebiotics is a promising therapeutic candidate to reduce serum UA levels in renal failure patients, and this urate-lowering effect could possibly be attributed to intestinal microbial degradation of UA. TRIAL REGISTRY: This study was registered at the Chinese Clinical Trials Registry ( http://www.chictr.org.cn/ ), registration ID: ChiCTR-INR-17013739, registration date: 6th Dec 2017.
PURPOSE: Increased levels of uric acid (UA), which is mainly excreted through the kidneys, are independently associated with higher mortality in end-stage renal disease (ESRD) patients. The uricolysis of gut microbiota plays an important role in extrarenal excretion of UA. This study aimed to examine the effect of inulin-type prebiotics (a type of fermentable dietary fiber) on intestinal microbiota modulation and serum UA levels in ESRD patients. METHODS: Continuous ambulatory peritoneal dialysis (CAPD) patients were recruited to a randomized, double-blind, placebo-controlled crossover trial of 12-week inulin-type prebiotics. Participants were visited before and after treatment with prebiotics or placebo. Serum UA levels, dietary purine intake, serum xanthine oxidase (XO) activity, daily "renal excretion" of UA, and fecal UA degradation capability were measured at each visit. Fecal metagenomic analysis was conducted to assess microbial composition and function. RESULTS: Sixteen participants (mean age = 37 y; 10 men and 6 women) completed the trial, and 64 specimens were analyzed. The average concentration of serum UA decreased by approximately 10% in the prebiotic intervention group in comparison to the placebo group (p = 0.047) without an increase in daily "renal excretion" of UA via urine and dialysate. There were no significant changes in purine intake or activity of XO. Notably, enhanced fecal UA degradation was observed after prebiotic intervention (p = 0.041), and the ratio of Firmicutes/Bacteroidetes, which was positively associated with fecal UA degradation, increased in the prebiotic period (p = 0.032). Furthermore, prebiotics enriched purine-degrading species in the gut microbiota, including unclassified_o_Clostridiales, Clostridium sp. CAG:7, Clostridium sp. FS41, Clostridium citroniae, Anaerostipes caccae, and Clostridium botulinum. CONCLUSIONS: Inulin-type prebiotics is a promising therapeutic candidate to reduce serum UA levels in renal failure patients, and this urate-lowering effect could possibly be attributed to intestinal microbial degradation of UA. TRIAL REGISTRY: This study was registered at the Chinese Clinical Trials Registry ( http://www.chictr.org.cn/ ), registration ID: ChiCTR-INR-17013739, registration date: 6th Dec 2017.
Authors: William B White; Kenneth G Saag; Michael A Becker; Jeffrey S Borer; Philip B Gorelick; Andrew Whelton; Barbara Hunt; Majin Castillo; Lhanoo Gunawardhana Journal: N Engl J Med Date: 2018-03-12 Impact factor: 91.245
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Patrick Albertus; John Ayanian; Rajesh Balkrishnan; Jennifer Bragg-Gresham; Jie Cao; Joline L T Chen; Elizabeth Cope; Sai Dharmarajan; Xue Dietrich; Ashley Eckard; Paul W Eggers; Charles Gaber; Daniel Gillen; Debbie Gipson; Haoyu Gu; Susan M Hailpern; Yoshio N Hall; Yun Han; Kevin He; Paul Hebert; Margaret Helmuth; William Herman; Michael Heung; David Hutton; Steven J Jacobsen; Nan Ji; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Ronit Katz; Csaba P Kovesdy; Vivian Kurtz; Danielle Lavalee; Yi Li; Yee Lu; Keith McCullough; Miklos Z Molnar; Maria Montez-Rath; Hal Morgenstern; Qiao Mu; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Jeffrey Pearson; Ronald Pisoni; Brett Plattner; Friedrich K Port; Praveen Potukuchi; Panduranga Rao; Kaitlyn Ratkowiak; Vanessa Ravel; Debabrata Ray; Connie M Rhee; Douglas E Schaubel; David T Selewski; Sally Shaw; Jiaxiao Shi; Monica Shieu; John J Sim; Peter Song; Melissa Soohoo; Diane Steffick; Elani Streja; Manjula Kurella Tamura; Francesca Tentori; Anca Tilea; Lan Tong; Megan Turf; Dongyu Wang; Mia Wang; Kenneth Woodside; April Wyncott; Xin Xin; Wei Zang; Lindsay Zepel; Sai Zhang; Hui Zho; Richard A Hirth; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2017-03 Impact factor: 8.860
Authors: Yuka Sato; Daniel I Feig; Austin G Stack; Duk-Hee Kang; Miguel A Lanaspa; A Ahsan Ejaz; L Gabriela Sánchez-Lozada; Masanari Kuwabara; Claudio Borghi; Richard J Johnson Journal: Nat Rev Nephrol Date: 2019-07-11 Impact factor: 28.314