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1.
J Ren Nutr ; 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32952005

RESUMO

Considering the Covid-19 pandemic and that patients with CKD are included in a high-risk group, a quick nutrition guide for patients with CKD in all stages was developed, and it is available in Portuguese at https://bit.ly/2zfSjl0, in English at https://bit.ly/covid19ckd, in Spanish at https://bit.ly/guia enfermedad renal and in French at https://bit.ly/covid19maladierenale.

2.
Food Res Int ; 136: 109306, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32846516

RESUMO

Inflammatory and innate immune responses triggered by pathogen-associated and other danger-associated signals emerging during infections, results in the activation of cytosolic inflammasomes. The nod-like receptor pyrin domain containing 3 (NLRP3) is one of the inflammasomes mediating such responses through the activation of caspase-1, which increases the production and release of pro-inflammatory cytokines, such as IL-1ß and IL-18 and induces programmed cell death through pyroptosis. NLRP3 is thought to play a crucial role in the underlying inflammatory responses in many lifestyles related chronic diseases. Consequently, research on the NLRP3 inflammasome has expanded dramatically in recent years. Although several studies have investigated the role of NLRP3 activation in chronic kidney disease (CKD), few studies have evaluated strategies to modulate its activation by means of interventions using non-pharmacological strategies. This review discusses some nutritional strategies (bioactive compounds, probiotics and caloric restriction) that have been shown to influence NLRP3 in experimental models of renal disease, and in CKD. It discusses how nutritional interventions could potentially dampen NLRP3 associated inflammatory burden, as part of nutritional strategies to prevent and treat CKD and its complications.

3.
J Ren Nutr ; 2020 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-32693969

RESUMO

OBJECTIVE: The aim of this study was to evaluate the association between zinc plasma levels and sensory perception in patients with chronic kidney disease (CKD). METHODS: A cross-sectional study with 21 nondialysis CKD patients (11 men, 51.1 ± 7.1 years, body mass index 27.9 ± 7.1 kg/m2, estimated glomerular filtration rate 32.7 ± 19.9 mL/min) and 22 non-CKD volunteers (10 men, 49.8 ± 8.3 years, body mass index 28.5 ± 5.4 kg/m2) was conducted. Blood samples were collected to obtain plasma for zinc analysis. Anthropometric and biochemical parameters, as well as food intake and salivary flow rate, were also evaluated. Taste sensory perception for sweet, acidic, bitter, and salty flavors was determined by the "three-drop method," with 4 concentrations of the 4 basic tastes. RESULTS: As expected, zinc plasma levels were significantly lower in CKD patients (70.1 ± 19.2ug/dL) when compared with the control group participants (123.2 ± 24.6 µg dL) (P ˂ .0001). The bitter taste perception was lower in the CKD group (p˂0.0001). Our findings showed that sensitivity to sour (P = .047), salty (P = .03), and bitter tastes was significantly lower in participants with lower zinc plasma levels. Also, bitter taste sensitivity was lower in participants with less zinc intake (P = .038). When grouping control subjects and CKD patients, significant correlations were observed between zinc plasma levels and the number of correct answers for bitter taste (r = 0.49, P = .001), number of correct answers for salty taste (r = 0.30, P = .048), and total score of correct answers (r = 0.30, P = .044). CONCLUSIONS: Reduced zinc plasma levels in nondialysis CKD patients may be associated with lower perception of bitter, sour, and salty tastes and strategies to restore these levels are crucial due many factors, including food preferences and intake.

4.
Clin Nutr ; 2020 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-32718711

RESUMO

Chocolate is a widely appreciated foodstuff with historical appreciation as a food from the gods. In addition to its highly palatable taste, it is a rich source of (poly)phenolics, which have several proposed salutogenic effects, including neuroprotective anti-inflammatory, anti-oxidant and cardioprotective capabilities. Despite the known benefits of this ancient foodstuff, there is a paucity of information on the effects of chocolate in the context of chronic kidney disease (CKD). This review focusses on the potential salutogenic contribution of chocolate intake, to mitigate inflammatory and oxidative burden in CKD, its potential, for cardiovascular protection and on the maintenance of diversity in gut microbiota, as well as clinical perspectives, on regular chocolate intake by CKD patients.

5.
J Bras Nefrol ; 2020 May 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32459280

RESUMO

BACKGROUND: Patients with chronic kidney disease (CKD) present an imbalance of the gut microbiota composition, leading to increased production of uremic toxins like p-cresyl sulfate (PCS), product from bacterial fermentation of the amino acids tyrosine (Tyr) and phenylalanine (Phe) from the diet. Thus, diet may be a determinant in the uremic toxins levels produced by the gut microbiota. The aim of this study was to evaluate the possible relationship between Tyr and Phe intake and PCS plasma levels in non-dialysis CKD patients. METHODS: Twenty-seven non-dialysis CKD patients (stages 3 and 4) without previous nutritional intervention were evaluated. The dietary intake was evaluated using a 24-hour recall, 3-day food record and protein intake was also estimated by Protein Nitrogen Appearance (PNA). The plasma levels of PCS were measured using reverse phase high performance liquid chromatography. RESULTS: The evaluated patients (GRF, 34.8 ± 12.4 mL/min, 54.2 ± 14.3 years, BMI, 29.3 ± 6.1 kg/m2) presented mean protein intake of 1.1 ± 0.5 g/kg/day), Tyr of 4.5 ± 2.4 g/day and Phe of 4.6 ± 2.5 g/day. PCS plasma levels (20.4 ± 15.5 mg/L) were elevated and positively associated with both, Tyr (r = 0.58, p = 0.002) and Phe intake (r = 0.53, p = 0.005), even after adjustments for eGFR and age. CONCLUSION: This study suggests that the diet is an important modulator of the uremic toxins plasma levels produced by the gut microbiota, in non-dialysis CKD patients.

6.
J Bras Nefrol ; 2020 May 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32459282

RESUMO

INTRODUCTION: Gut microbiota imbalance is linked to high uremic toxins production such as indole-3-acetic acid (IAA) in chronic kidney disease patients. This toxin can activate the aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor involved with inflammation. Strategies to restore gut microbiota balance can be associated with reduced production of IAA and its deleterious effects. This study aimed to evaluate prebiotic resistant starch (RS) supplementation effects on IAA plasma levels and AhR mRNA expression in CKD patients on hemodialysis (HD). METHODS: This randomized, double-blind and placebo-controlled clinical trial evaluated forty-two stable HD patients allocated in RS (n=22) or placebo (n=20) groups. Patients received, alternately, cookies and sachets containing 16 g/day of RS (Hi-Maize 260®) or manioc flour for four weeks. Fasting pre-dialysis blood samples were collected and IAA plasma levels measured by high performance liquid chromatography. Peripheral blood mononuclear cells were isolated and processed for AhR and nuclear factor kappa B (NF-κB) mRNA expression analyzes by quantitative real-time PCR. Anthropometric and biochemical parameters, as well as food intake were also evaluated. RESULTS: Thirty-one patients completed the study, 15 in the RS group and 16 in the placebo group. Although there was no significant alteration in IAA plasma levels, neither in AhR mRNA expression and NF-κB mRNA expression after RS supplementation, a positive correlation (r=0.48; p=0.03) was observed between IAA plasma levels and AhR expression at baseline. CONCLUSION: Even though prebiotic RS supplementation did not influence IAA levels or AhR expression, their positive association reinforces a possible interaction between them.

7.
Nephrol Dial Transplant ; 35(7): 1094-1098, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32417896
8.
Food Funct ; 11(3): 2617-2625, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32159187

RESUMO

BACKGROUND: The aim of this study was to evaluate the effect of resistant starch (RS) enriched cookies supplementation on mRNA expression of nuclear transcription factors (nuclear erythroid 2-related factor, Nrf2; nuclear factor kappa-B, NF-κB), involved with inflammation and on uremic toxins levels produced by the gut microbiota in hemodialysis (HD) patients. METHODS: A randomized, double-blind, placebo-controlled crossover study with 26 HD patients was conducted. The patients were assigned to either resistant starch enriched cookies (16 g of RS per day) or placebo cookies supplementation during the first four weeks. After the washout period, patients were supplemented again, in the form of a crossover, for another 4 weeks. Nrf2, NF-κB, and antioxidant enzymes mRNA expression were measured by rt-PCR and protein expression by western blotting assay from isolated peripheral blood mononuclear cells (PBMC). Oxidative stress and inflammatory biomarkers, as well as uremic toxins, were evaluated. Intention-to-treat analysis was performed, using the proc mixed procedure in SAS. RESULTS: In RS group, post-treatment mean mRNA Nrf2 expression was market increased from baseline values, associated with a high expression of NQO1 protein. Besides, IS plasma levels were reduced in the RS group. No significant difference was observed in the placebo group. CONCLUSION: Our results suggested that resistant starch enriched cookies may be a good nutritional strategy to reduce indoxyl sulfate levels derived from the gut microbiota and also attenuate the inflammation in hemodialysis patients.

9.
Clin Nutr ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32204978

RESUMO

BACKGROUND & AIMS: Chronic kidney disease (CKD) patients have numerous complications associated with inflammation, which is a potential driver for cardiovascular disease. Curcumin, a compound of the curcuminoid class produced by the Curcuma longa, has been reported to activate nuclear factor erythroid factor 2-related (Nrf2) and inhibit nuclear factor kappa-B (NF-kB). Our aim was to evaluate the effects of curcumin juice on the expression of inflammatory transcription factors in hemodialysis (HD) patients. METHODS AND RESULTS: This double-blind randomized pilot study included 31 HD patients divided into two groups: curcumin group (receiving 100 mL of orange juice with 12 g of carrot and 2.5 g of turmeric after each dialysis session/week for 3 months) and control group (receiving the same juice without curcumin); 14 patients in each arm completed the study. The mRNA expression of Nrf2, NF-kB, NLRP3 inflammasome and IL-1ß in peripheral blood mononuclear cells (PBMC; using real-time quantitative polymerase chain reaction, qPCR) and routine biochemistries, food intake and anthropometrics were analyzed. After three months of supplementation, the curcumin group showed a significant decrease in NF-kB mRNA expression (AU) [from 1.08 (0.77-1.38) to 0.52 (0.32-0.95),p = 0.02] and in plasma high sensitivity C-reactive protein (hsCRP) levels [from 3.8 (2.5-6.8) to 2.0 (1.1-3.8) mg/L, p = 0.04]. There was no change in the other evaluated markers. CONCLUSION: Three months treatment with curcumin in CKD patients undergoing HD resulted in decreased markers of inflammation, NF-kB mRNA expression and hsCRP, suggesting that oral supplementation of curcumin may have an anti-inflammatory effect in this patient group. TRIAL REGISTRATION: Approved by the Ethics Committee of the Faculty of Medicine/UFF, number: 2.346.933. This study was registered within ClinicalTrials.gov under the number NCT03475017.

10.
Int Urol Nephrol ; 52(3): 549-555, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008198

RESUMO

PURPOSE: In chronic kidney disease (CKD) patients, dysbiosis is associated with inflammation and cardiovascular risk, so many nutritional strategies are being studied to reduce these complications. Resistant starch (RS) can be considered a prebiotic that promotes many benefits, including modulation of gut microbiota which is linked to immune-modulatory effects. The aim of this study was to evaluate the effects of RS supplementation on proinflammatory cytokines in CKD patients on hemodialysis (HD). METHODS: A double-blind, placebo-controlled, randomized trial was conducted with sixteen HD patients (55.3 ± 10.05 years, body mass index (BMI) 25.9 ± 5.42 kg/m2, 56% men, time on dialysis 38.9 ± 29.23 months). They were allocated to the RS group (16 g RS/day) or placebo group (manioc flour). The serum concentration of ten cytokines and growth factors was detected through a multiparametric immunoassay based on XMap-labeled magnetic microbeads (Luminex Corp, USA) before and after 4 weeks with RS supplementation. RESULTS: After RS supplementation, there was a reduction of Regulated upon Activation, Normal T-Cell Expressed and Secreted (p < 0.001), platelet-derived growth factor (two B subunits) (p = 0.014) and interferon-inducible protein 10 (IP-10) (p = 0.027). The other parameters did not change significantly. CONCLUSION: This preliminary result indicates that RS may contribute to a desirable profile of inflammatory markers in CKD patients.

11.
J Ren Nutr ; 30(1): 46-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30956090

RESUMO

OBJECTIVE(S): Low protein diets (LPD; 0.6 g/kg/day), prescribed for nondialysis chronic kidney disease (CKD) patients, have demonstrated numerous benefits. LPDs may modulate inflammation and oxidative stress through the nuclear factor erythroid 2-related factor 2 (Nrf2), which encodes antioxidant and phase II detoxifying enzymes. LPDs also inhibit or antagonize nuclear factor kB (NF-kB) activity, which orchestrates inflammatory and oxidative stress responses. The objective of this study was to evaluate the effects of LPD on Nfr2 and NF-κB messenger RNA (mRNA) expression in nondialysis CKD patients. METHODS: In this longitudinal study, a LPD was prescribed for 30 nondialysis CKD patients for 6 months. Peripheral blood mononuclear cells were isolated, and quantitative real-time polymerase chain reaction analysis was performed to evaluate Nrf2, NF-κB, and NADPH quinine oxidoreductase-1 mRNA expression. Thiobarbituric acid-reactive substance (TBARS) levels, a marker of lipid peroxidation, were also evaluated. RESULTS: (Age 55.5 ± 14.0 years; body mass index 29.1 ± 5.9 kg/m2; glomerular filtration rate 35.6 ± 12.2 mL/minute). After 6 months of nutritional intervention, Nrf2 mRNA expression increased from 0.85 (0.47-1.56) to 1.28 (0.63-2.63) nmol/mL (P = .03), and TBARS levels were significantly decreased from 1.78 (1.31-2.38) to 1.30 (1.07-2.22) nmol/mL (P = .04). NF-κB mRNA expression showed no significant difference after 6 months, but the Nrf2/NF-κB ratio was increased. CONCLUSION(S): In this study, a LPD appeared to modulate Nrf2 expression and decrease the levels of TBARS in nondialysis CKD patients. However, more studies are needed to confirm the effectiveness of LPD on the modulation of transcription factors involved with oxidative stress and inflammation in nondialysis CKD patients.

12.
Arq. bras. cardiol ; 113(6): 1121-1127, Dec. 2019. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1055071

RESUMO

Abstract Background: Oxidative stress and inflammation are present in coronary artery disease (CAD) and are linked to the activation of the transcription nuclear factor kappa B (NF-κB). To attenuate these complications, transcription factors like nuclear factor erythroid 2-related factor 2 (Nrf2) and peroxisome proliferator-activated receptor-β/δ (PPARβ/δ) can be activated to inhibit NF-κB. However, the available data on expression of NF-κB, Nrf2 and PPARβ/δ in CAD patients are limited. Objective: To evaluate the expression of the transcription factors NF-κB and Nrf2 and PPAR��/�� in CAD patients. Methods: Thirty-five patients (17 men, mean age 62.4 ? 7.55 years) with CAD and twelve patients (5 men, mean age 63.50 ? 11.46 years) without CAD were enrolled. Peripheral blood mononuclear cells (PBMCs) were isolated and processed for mRNA expression of Nrf2, NF-κB, NADPH: quinone oxidoreductase 1 (NQO1) and PPARβ/δ mRNAs using quantitative real-time polymerase chain reaction (qPCR). p < 0.05 was considered statistically significant. Results: There was no difference in the mRNA expressions of Nrf2 (1.35 ? 0.57), NF-κB (1.08 ? 0.50) or in the antioxidant enzyme NQO1 (1.05 ? 0.88) in the CAD group compared to the group without CAD (1.16 ? 0.76, 0.95 ? 0.33, 0.81 ? 0.55, respectively). However, PPARβ/δ was highest expressed in the CAD group (1.17 ? 0.86 vs. 0.56 ? 0.34, p = 0.008). Conclusion: The main finding of this study was the PPARβ/δ being more expressed in the PBMC of patients with CAD compared to the control group, whereas no differences were observed in Nrf2 or NF-κB mRNA expressions.


Resumo Fundamentos: O estresse oxidativo e a inflamação estão presentes na doença arterial coronariana (DAC) e estão ligados à ativação do fator de transcrição nuclear kappa B (NF-κB). Para atenuar essas complicações, fatores de transcrição como o fator nuclear eritroide 2-relacionado ao fator 2 (Nrf2) e o receptor ativado por proliferador de peroxissoma β/δ (PPARβ/δ) podem ser ativados para inibir o NF-κB. No entanto, os dados disponíveis sobre a expressão de NF-κB, Nrf2 e PPARβ/δ em pacientes com DAC são limitados. Objetivo: Avaliar a expressão dos fatores transcricionais NF-κB e Nrf2 e o PPARβ/δ em pacientes com DAC. Métodos: Trinta e cinco pacientes (17 homens, idade média de 62,4 ± 7,55 anos) com DAC e doze pacientes (5 homens, com idade média de 63,50 ± 11,46 anos) sem DAC foram incluídos. Células mononucleares do sangue periférico (PBMCs) foram isoladas e processadas para a expressão de mRNA do Nrf2, NF-κB, NADPH: quinona oxidoredutase 1 (NQO1) e mRNAs do PPARβ/δ por meio de reação em cadeia da polimerase quantitativa em tempo real (qPCR). Valores de p < 0,05 foram considerados como estatisticamente significativos. Resultados: Não houve diferença nas expressões de mRNA do Nrf2 (1,35 ± 0,57), NF-κB (1,08 ± 0,50) ou na enzima antioxidante NQO1 (1,05 ± 0,88) no grupo DAC em comparação com o grupo sem DAC (1,16 ± 0,76, 0,95 ± 0,33, 0,81 ± 0,55, respectivamente). Entretanto, o PPARβ/δ apresentou maior expressão no grupo com DAC (1,17 ± 0,86 vs. 0,56 ± 0,34, p = 0,008). Conclusão: O principal achado do presente estudo foi o PPARβ/δ apresentar maior expressão nas PBMCs de pacientes com DAC comparados ao grupo controle, ao passo que não foram observadas diferenças nas expressões de mRNA do Nrf2 ou NF-κB.

13.
Arq Bras Cardiol ; 113(6): 1121-1127, 2019 12.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340238

RESUMO

BACKGROUND: Oxidative stress and inflammation are present in coronary artery disease (CAD) and are linked to the activation of the transcription nuclear factor kappa B (NF-κB). To attenuate these complications, transcription factors like nuclear factor erythroid 2-related factor 2 (Nrf2) and peroxisome proliferator-activated receptor-ß/δ (PPARß/δ) can be activated to inhibit NF-κB. However, the available data on expression of NF-κB, Nrf2 and PPARß/δ in CAD patients are limited. OBJECTIVE: To evaluate the expression of the transcription factors NF-κB and Nrf2 and PPAR𝛽/𝛿 in CAD patients. METHODS: Thirty-five patients (17 men, mean age 62.4 ? 7.55 years) with CAD and twelve patients (5 men, mean age 63.50 ? 11.46 years) without CAD were enrolled. Peripheral blood mononuclear cells (PBMCs) were isolated and processed for mRNA expression of Nrf2, NF-κB, NADPH: quinone oxidoreductase 1 (NQO1) and PPARß/δ mRNAs using quantitative real-time polymerase chain reaction (qPCR). p < 0.05 was considered statistically significant. RESULTS: There was no difference in the mRNA expressions of Nrf2 (1.35 ? 0.57), NF-κB (1.08 ? 0.50) or in the antioxidant enzyme NQO1 (1.05 ? 0.88) in the CAD group compared to the group without CAD (1.16 ? 0.76, 0.95 ? 0.33, 0.81 ? 0.55, respectively). However, PPARß/δ was highest expressed in the CAD group (1.17 ? 0.86 vs. 0.56 ? 0.34, p = 0.008). CONCLUSION: The main finding of this study was the PPARß/δ being more expressed in the PBMC of patients with CAD compared to the control group, whereas no differences were observed in Nrf2 or NF-κB mRNA expressions.

14.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 274-282, May-June 2019. tab, ilus
Artigo em Inglês | LILACS | ID: biblio-1002225

RESUMO

Cardiovascular diseases (CVD) are the main cause of death globally and most CVD can be prevented by addressing their risk factors, such as an unhealthy diet. Many authors have studied the benefits of nut consumption on CVD. Nuts contain high amounts of vegetable protein, unsaturated fatty acids, dietary fibers, vitamins, minerals and many other bioactive compounds, like phytosterols and phenolic compounds, which are able to reduce cholesterol levels and promote antioxidant and anti-inflammatory effects, thereby reducing cardiovascular risks. This review aims to describe studies involving the consumption of nuts, including Brazil nuts and CVD risk factors with positive results in the improvement of lipid profile, glucose metabolism, vascular function, and inflammatory and oxidative stress biomarkers


Assuntos
Humanos , Masculino , Feminino , Brasil , Doenças Cardiovasculares/mortalidade , Nozes , Sementes , Biomarcadores , Colesterol , Fatores de Risco , Dieta Rica em Proteínas , Hipertensão , HDL-Colesterol/análise , LDL-Colesterol/análise , Anti-Inflamatórios , Antioxidantes
15.
Food Funct ; 10(6): 3103-3112, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31140512

RESUMO

Patients with chronic kidney disease (CKD) present many complications that potentially could be linked to increased cardiovascular mortality such as inflammation, oxidative stress, cellular senescence and gut dysbiosis. There is growing evidence suggesting that nutritional strategies may reduce some of these complications. Clinical studies suggest that supplementation of cranberries may have beneficial effects on human health such as prevention of urinary tract infections. More recently, the anti-inflammatory and anti-oxidant effects as well as modulation of gut microbiota provided by cranberry phytochemicals have drawn more attention. A better understanding of possible effects and mechanisms of action of cranberry supplementation in humans could inform researchers about warranted future directions for clinical studies targeting these complications in CKD patients by applying nutritional strategies involving cranberry supplementation.


Assuntos
Insuficiência Renal Crônica/dietoterapia , Vaccinium macrocarpon/metabolismo , Animais , Microbioma Gastrointestinal , Humanos , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/microbiologia , Vaccinium macrocarpon/química
16.
Int. j. cardiovasc. sci. (Impr.) ; 32(3): 274-282, may.-june. 2019. ilus, tab
Artigo em Inglês | LILACS | ID: biblio-1006132

RESUMO

Cardiovascular diseases (CVD) are the main cause of death globally and most CVD can be prevented by addressing their risk factors, such as an unhealthy diet. Many authors have studied the benefits of nut consumption on CVD. Nuts contain high amounts of vegetable protein, unsaturated fatty acids, dietary fibers, vitamins, minerals and many other bioactive compounds, like phytosterols and phenolic compounds, which are able to reduce cholesterol levels and promote antioxidant and anti-inflammatory effects, thereby reducing cardiovascular risks. This review aims to describe studies involving the consumption of nuts, including Brazil nuts and CVD risk factors with positive results in the improvement of lipid profile, glucose metabolism, vascular function, and inflammatory and oxidative stress biomarkers


Assuntos
Humanos , Masculino , Feminino , Brasil , Doenças Cardiovasculares/mortalidade , Nozes , Sementes , Biomarcadores , Colesterol , Fatores de Risco , Dieta Rica em Proteínas , Hipertensão , HDL-Colesterol/análise , LDL-Colesterol/análise , Anti-Inflamatórios , Antioxidantes
17.
Biochemistry ; 58(15): 2054-2060, 2019 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-30912928

RESUMO

Recent studies have suggested that uremic toxins such as indoxyl sulfate (IS) and indole-3-acetic acid (IAA) from the metabolism of the gut microbiota may be involved in the inflammatory signaling pathway in chronic kidney disease (CKD) patients through the activation of the aryl hydrocarbon receptor (AhR), a ligand-activated transcription factor. The objective of this study was to investigate the possible relationship between uremic toxins (IS and IAA) and AhR protein expression in CKD patients. A cross-sectional observational study involving 17 hemodialysis (HD) [11 men, 55.5 ± 11.7 years of age, 54.0 (25.5-136.0) months of HD, body mass index (BMI) of 25.8 ± 3.8 kg/m2] and 15 non-dialysis-dependent (NDD) CKD (8 men, 54.1 ± 18.2 years of age, glomerular filtration rate of 34.8 ± 21.0 mL/min/1.73 m2, BMI of 27.4 ± 5.0 kg/m2) patients was conducted. IS and IAA levels were measured by reversed-phase high-performance liquid chromatography, and the protein expression levels of AhR and nuclear factor κ B (NF-κB) were evaluated by a Western blot assay. There was no difference in the expression of either AhR or NF-κB in the patients, and as expected, uremic toxin levels were higher in HD patients than in NDD patients. In the overall analysis, AhR protein expression was positively associated with IAA plasma levels ( r = 0.4; p = 0.03) and NF-κB protein expression ( r = 0.62; p = 0.001). Although the role of AhR in inflammation and CVD in CKD patients is far from being completely understood, the association between IAA and AhR observed in this study suggests a possible role for uremic toxins in the cell signaling pathway involved in inflammation in CKD patients.


Assuntos
Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Microbioma Gastrointestinal/fisiologia , Receptores de Hidrocarboneto Arílico/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Toxinas Biológicas/metabolismo , Adulto , Idoso , Bactérias/metabolismo , Estudos Transversais , Feminino , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/microbiologia , Humanos , Indicã/metabolismo , Ácidos Indolacéticos/metabolismo , Masculino , Pessoa de Meia-Idade , NF-kappa B/metabolismo , Insuficiência Renal Crônica/terapia , Transdução de Sinais
18.
Nutrients ; 11(3)2019 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-30818761

RESUMO

Gut microbiota imbalance is common in patients with chronic kidney disease (CKD) and associates with factors such as increased circulating levels of gut-derived uremic toxins, inflammation, and oxidative stress, which are linked to cardiovascular disease and increased morbimortality. Different nutritional strategies have been proposed to modulate gut microbiota, and could potentially be used to reduce dysbiosis in CKD. Nutrients like proteins, fibers, probiotics, and synbiotics are important determinants of the composition of gut microbiota and specific bioactive compounds such as polyphenols present in nuts, berries. and fruits, and curcumin, may also play a key role in this regard. However, so far, there are few studies on dietary components influencing the gut microbiota in CKD, and it is therefore not possible to conclude which nutrients should be prioritized in the diet of patients with CKD. In this review, we discuss some nutrients, diet patterns and bioactive compounds that may be involved in the modulation of gut microbiota in CKD and provide the background and rationale for studies exploring whether nutritional interventions with these dietary components could be used to alleviate the gut dysbiosis in patients with CKD.


Assuntos
Dieta , Disbiose , Microbioma Gastrointestinal , Insuficiência Renal Crônica/microbiologia , Humanos , Probióticos , Simbióticos
19.
J Nutr ; 149(3): 372-380, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30796783

RESUMO

Epigenetic alterations, such as those linked to DNA methylation, may potentially provide molecular explanations for complications associated with altered gene expression in illnesses, such as chronic kidney disease (CKD). Although both DNA hypo- and hypermethylation have been observed in the uremic milieu, this remains only a single aspect of the epigenetic landscape and, thus, of any biochemical dysregulation associated with CKD. Nevertheless, the role of uremia-promoting alterations on the epigenetic landscape regulating gene expression is still a novel and scarcely studied field. Although few studies have actually reported alterations of DNA methylation via methyl donor nutrient intake, emerging evidence indicates that nutritional modification of the microbiome can affect one-carbon metabolism and the capacity to methylate the genome in CKD. In this review, we discuss the nutritional modifications that may affect one-carbon metabolism and the possible impact of methyl donor nutrients on the microbiome, CKD, and its phenotype.


Assuntos
Metilação de DNA , Epigênese Genética/fisiologia , Regulação da Expressão Gênica/fisiologia , Insuficiência Renal Crônica/metabolismo , Envelhecimento , Humanos , Estado Nutricional
20.
Hemodial Int ; 23(2): 189-197, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30779317

RESUMO

INTRODUCTION: Indoxyl sulfate (IS) and p-cresyl sulfate (p-CS) are albumin-bound uremic toxins that are difficult to remove by hemodialysis (HD). Human serum albumin (HSA) carries several compounds, including fatty acids that can bind to site II of HSA and represent competing ligands for uremic toxins. The aim of this study was to investigate the association between fatty acids and uremic toxin plasma levels in patients undergoing HD. METHODS: Thirty-three HD patients (51.5% male, 54.9 ± 10.2 years old, 44.63 ± 28.4 months on HD, albumin level of 3.8 ± 0.3 g/dL) were evaluated. The erythrocyte fatty acid content (saturated fatty acid [SFA], monounsaturated fatty acid [MUFA], and polyunsaturated fatty acid [PUFA]) was measured by gas chromatography, and total IS and p-CS plasma levels were measured by reversed-phase high-performance liquid chromatography. FINDINGS: The mean percentages of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) + DHA and gamma-linolenic (GLA) acid in the erythrocyte membrane were 1.35% ± 0.74%, 1.85% ± 0.79%, and 0.33% ± 0.26%, respectively. The mean levels of IS and p-CS were 19.4 ± 11.9 mg/dL and 101.5 ± 57.2 mg/dL, respectively. There was no significant association between SFA and MUFA and IS and p-CS; however, a negative correlation was found between p-CS and specific PUFAs, and the association between GLA and p-CS levels was retained after adjusting for potential confounding variables (ß = -0.49, P = 0.007). DISCUSSION: Polyunsaturated fatty acids may contribute to the decrease in p-CS uremic toxin plasma levels in patients with chronic kidney disease undergoing HD.

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