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Supplementation of Short-Chain Fatty Acid, Sodium Propionate, in Patients on Maintenance—'Beneficial Effects on Inflammatory Parameters and Gut-Derived Uremic Toxins'—A Pilot Study (PLAN Study)
- Source :
- Journal of Clinical Medicine, Volume 7, Issue 10, Journal of Clinical Medicine, Vol 7, Iss 10, p 315 (2018)
- Publication Year :
- 2018
- Publisher :
- MDPI AG, 2018.
-
Abstract
- Background: In end-stage renal disease (ESRD), gut-derived uremic toxins play a fundamental role in the systemic inflammation and oxidative stress promoting the excess morbidity and mortality. The biochemical derangement is in part a consequence of an insufficient generation of short-chain fatty acids (SCFA) due to the dysbiosis of the gut and an insufficient consumption of the fermentable complex carbohydrates. Aim of the study: The primary end-point was to evaluate the potential efficacy of SCFA (specifically, sodium propionate (SP)) for patients on maintenance hemodialysis (MHD) on systemic inflammation. Secondary end-points included potential attenuation of oxidative stress markers, insulin resistance and production of gut-derived uremic toxins indoxyl sulfate and p-cresol sulfate, as well as health status after SP supplementation. Study design: We performed a single-center non-randomized pilot study in 20 MHD patients. They received the food additive SP with a daily intake of 2 &times<br />500 mg in the form of capsules for 12 weeks. Pre-dialysis blood samples were taken at the beginning, after six weeks and at the end of the administration period, as well as four weeks after stopping the treatment. Results: The subjects revealed a significant decline of inflammatory parameters C-reactive protein (&minus<br />46%), interleukin IL-2 (&minus<br />27%) and IL-17 (&minus<br />15%). The inflammatory parameters IL-6 and IFN-gamma showed a mild non-significant reduction, while the anti-inflammatory cytokine IL-10 increased significantly (+71%). While the concentration of bacterial endotoxins and TNF-&alpha<br />remained unchanged, the gut-derived uremic toxins, indoxyl sulfate (&minus<br />30%) and p-cresyl sulfate (&minus<br />50%), revealed a significant decline. The SP supplementation reduced the parameters of oxidative stress malondialdehyde (&minus<br />32%) and glutathione peroxidase activity (&minus<br />28%). The serum insulin levels dropped by 30% and the HOMA-index by 32%. The reduction of inflammatory parameters was associated with a lowering of ferritin and a significant increase in transferrin saturation (TSAT). Four weeks after the end of the treatment phase, all improved parameters deteriorated again. Evaluation of the psycho-physical performance with the short form 36 (SF-36) questionnaire showed an enhancement in the self-reported physical functioning, general health, vitality and mental health. The SP supplementation was well tolerated and without important side effects. No patient had left the study due to intolerance to the medication. The SP supplementation in MHD patients reduced pro-inflammatory parameters and oxidative stress and improved insulin resistance and iron metabolism. Furthermore, SP effectively lowered the important gut-derived uremic toxins indoxyl and p-cresol sulfate. These improvements were associated with a better quality of life. Further controlled studies are required in a larger cohort to evaluate the clinical outcome.
- Subjects :
- chronic kidney disease
gut microbiome
hemodialysis
indoxyl sulfate
p-cresyl sulfate
propionic acid
systemic micro-inflammation oxidative stress
0301 basic medicine
medicine.medical_specialty
medicine.medical_treatment
030232 urology & nephrology
lcsh:Medicine
medicine.disease_cause
Systemic inflammation
Article
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Insulin resistance
Internal medicine
medicine
ddc:610
biology
Transferrin saturation
business.industry
lcsh:R
Short-chain fatty acid
General Medicine
medicine.disease
Malondialdehyde
Ferritin
030104 developmental biology
Endocrinology
chemistry
biology.protein
Hemodialysis
medicine.symptom
business
Oxidative stress
Subjects
Details
- ISSN :
- 20770383
- Volume :
- 7
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Medicine
- Accession number :
- edsair.doi.dedup.....6e883ba44b965dd05db66b6bba6f2847