Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease.
Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease.
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DOI：
10.3390/nu9050489
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发表时间：
2017-05-12
期刊：
影响因子：
5.9
通讯作者：
Sanchez-Niño MD
中科院分区：
文献类型：
--
作者：
Fernandez-Prado R;Esteras R;Perez-Gomez MV;Gracia-Iguacel C;Gonzalez-Parra E;Sanz AB;Ortiz A;Sanchez-Niño MD
在慢性肾脏病（CKD）中，尿毒症毒素的积累与死亡风险增加相关。一些尿毒症毒素是通过饮食摄入的，例如磷酸盐和杨桃衍生的胡萝卜素。其他则是由肠道微生物群的营养处理产生的，产生尿毒症毒素的前体或尿毒症毒素本身。这些营养素包括左旋肉碱、胆碱/磷脂酰胆碱、色氨酸和酪氨酸，它们也作为营养补充剂在非处方药销售。医生和患者都应该意识到，在 CKD 患者中，使用这些补充剂可能会导致潜在的毒性作用。不幸的是，大多数 CKD 患者并不知道自己的病情。一些饮食成分可能会改变肠道微生物群，增加处理它们产生尿毒症毒素的细菌数量，例如氧化三甲胺 (TMAO)、硫酸对甲苯酯、硫酸吲哚酚和 3-吲哚乙酸。营养源性尿毒症毒素的循环水平与死亡和心血管疾病风险增加有关，有证据表明这种关联可能是因果关系。未来的发展可能包括改变肠道处理或这些营养素或衍生物的吸收，以改善 CKD 患者的预后。
In chronic kidney disease (CKD), accumulation of uremic toxins is associated with an increased risk of death. Some uremic toxins are ingested with the diet, such as phosphate and star fruit-derived caramboxin. Others result from nutrient processing by gut microbiota, yielding precursors of uremic toxins or uremic toxins themselves. These nutrients include l-carnitine, choline/phosphatidylcholine, tryptophan and tyrosine, which are also sold over-the-counter as nutritional supplements. Physicians and patients alike should be aware that, in CKD patients, the use of these supplements may lead to potentially toxic effects. Unfortunately, most patients with CKD are not aware of their condition. Some of the dietary components may modify the gut microbiota, increasing the number of bacteria that process them to yield uremic toxins, such as trimethylamine N-Oxide (TMAO), p-cresyl sulfate, indoxyl sulfate and indole-3 acetic acid. Circulating levels of nutrient-derived uremic toxins are associated to increased risk of death and cardiovascular disease and there is evidence that this association may be causal. Future developments may include maneuvers to modify gut processing or absorption of these nutrients or derivatives to improve CKD patient outcomes.