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Caggiano G, Stasi A, Franzin R, Fiorentino M, Cimmarusti MT, Deleonardis A, Palieri R, Pontrelli P, Gesualdo L. Fecal Microbiota Transplantation in Reducing Uremic Toxins Accumulation in Kidney Disease: Current Understanding and Future Perspectives. Toxins (Basel) 2023; 15:toxins15020115. [PMID: 36828429 PMCID: PMC9965504 DOI: 10.3390/toxins15020115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
During the past decades, the gut microbiome emerged as a key player in kidney disease. Dysbiosis-related uremic toxins together with pro-inflammatory mediators are the main factors in a deteriorating kidney function. The toxicity of uremic compounds has been well-documented in a plethora of pathophysiological mechanisms in kidney disease, such as cardiovascular injury (CVI), metabolic dysfunction, and inflammation. Accumulating data on the detrimental effect of uremic solutes in kidney disease supported the development of many strategies to restore eubiosis. Fecal microbiota transplantation (FMT) spread as an encouraging treatment for different dysbiosis-associated disorders. In this scenario, flourishing studies indicate that fecal transplantation could represent a novel treatment to reduce the uremic toxins accumulation. Here, we present the state-of-the-art concerning the application of FMT on kidney disease to restore eubiosis and reverse the retention of uremic toxins.
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García-Martínez Y, Borriello M, Capolongo G, Ingrosso D, Perna AF. The Gut Microbiota in Kidney Transplantation: A Target for Personalized Therapy? Biology (Basel) 2023; 12:biology12020163. [PMID: 36829442 PMCID: PMC9952448 DOI: 10.3390/biology12020163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Kidney transplantation improves quality of life, morbidity, and mortality of patients with kidney failure. However, integrated immunosuppressive therapy required to preserve graft function is associated with the development of post-transplant complications, including infections, altered immunosuppressive metabolism, gastrointestinal toxicity, and diarrhea. The gut microbiota has emerged as a potential therapeutic target for personalizing immunosuppressive therapy and managing post-transplant complications. This review reports current evidence on gut microbial dysbiosis in kidney transplant recipients, alterations in their gut microbiota associated with kidney transplantation outcomes, and the application of gut microbiota intervention therapies in treating post-transplant complications.
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Affiliation(s)
- Yuselys García-Martínez
- Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Via Pansini, Bldg 17, 80131 Naples, Italy
- Correspondence:
| | - Margherita Borriello
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Via Pansini, Bldg 17, 80131 Naples, Italy
| | - Diego Ingrosso
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 7, 80138 Naples, Italy
| | - Alessandra F. Perna
- Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Via Pansini, Bldg 17, 80131 Naples, Italy
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Przybyciński J, Drożdżal S, Wilk A, Dziedziejko V, Szumilas K, Pawlik A. The Effect of the Gut Microbiota on Transplanted Kidney Function. Int J Mol Sci 2023; 24:ijms24021260. [PMID: 36674775 PMCID: PMC9866452 DOI: 10.3390/ijms24021260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/23/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
The intestinal microflora is extremely important, not only in the processes of absorption, digestion and biosynthesis of vitamins, but also in shaping the immune and cognitive functions of the human body. Several studies demonstrate a correlation between microbiota composition and such events as graft rejection, kidney interstitial fibrosis, urinary tract infections, and diarrhoea or graft tolerance. Some of those changes might be directly linked with pathologies such as colonization with pathogenic bacterial strains. Gut microbiota composition also plays an important role in metabolic complications and viral infections after transplantation. From the other side, gut microbiota might induce graft tolerance by promotion of T and B regulatory cells. Graft tolerance induction is still an extremely important issue regarding transplantology and might allow the reduction or even avoidance of immunosuppressive treatment. Although there is a rising evidence of the pivotal role of gut microbiota in aspects of kidney transplantation there is still a lack of knowledge on the direct mechanisms of microbiota action. Furthermore, some of those negative effects could be reversed by probiotics of faecal microbiota trapoinsplantation. While diabetes and hypertension as well as BKV and CMV viremia are common and important complications of transplantation, both worsening the graft function and causing systemic injuries, it opens up potential clinical treatment options. As has been also suggested in the current review, some bacterial subsets exhibit protective properties. However, currently, there is a lack of evidence on pro- and prebiotic supplementation in kidney transplant patients. In the current review, we describe the effect of the microbiota on the transplanted kidney in renal transplant recipients.
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Affiliation(s)
- Jarosław Przybyciński
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Sylwester Drożdżal
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Wilk
- Department of Histology and Embryology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Violetta Dziedziejko
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Kamila Szumilas
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
- Correspondence:
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Koppe L, Soulage CO. Protein-bound uremic toxins: putative modulators of calcineurin inhibitors exposure. Nephrol Dial Transplant 2022; 37:2044-2047. [PMID: 35916444 DOI: 10.1093/ndt/gfac229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.,Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Christophe O Soulage
- Univ. Lyon, CarMeN lab, INSA-Lyon, INSERM U1060, INRA, Université Claude Bernard Lyon 1, Villeurbanne, France
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Korytowska N, Wyczałkowska-Tomasik A, Pączek L, Giebułtowicz J. Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients. Toxins (Basel) 2021; 13:571. [PMID: 34437442 PMCID: PMC8402605 DOI: 10.3390/toxins13080571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022] Open
Abstract
Acute kidney injury (AKI) is a significant risk factor for developing chronic kidney disease and progression to end-stage renal disease in elderly patients. AKI is also a relatively common complication after kidney transplantation (KTx) associated with graft failure. Since the lifespan of a transplanted kidney is limited, the risk of the loss/deterioration of graft function (DoGF) should be estimated to apply the preventive treatment. The collection of saliva and urine is more convenient than collecting blood and can be performed at home. The study aimed to verify whether non-invasive biomarkers, determined in saliva and urine, may be useful in the prediction of DoGF in kidney transplant recipients (KTRs) (n = 92). Salivary and serum toxins (p-cresol sulfate, pCS; indoxyl sulfate, IS) concentrations were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Urinary proteins, hemoglobin, and glucose were measured using a semi-quantitative strip test. Salivary IS (odds ratio (OR) = 1.19), and proteinuria (OR = 3.69) were demonstrated as independent factors for the prediction of DoGF. Satisfactory discriminatory power (area under the receiver operating characteristic curve (AUC) = 0.71 ± 0.07) and calibration of the model were obtained. The model showed that categories of the increasing probability of the risk of DoGF are associated with the decreased risk of graft survival. The non-invasive diagnostic biomarkers are a useful screening tool to identify high-risk patients for DoGF.
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Affiliation(s)
- Natalia Korytowska
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha, 02-097 Warsaw, Poland;
| | - Aleksandra Wyczałkowska-Tomasik
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, 59 Nowogrodzka, 02-006 Warsaw, Poland; (A.W.-T.); (L.P.)
| | - Leszek Pączek
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, 59 Nowogrodzka, 02-006 Warsaw, Poland; (A.W.-T.); (L.P.)
| | - Joanna Giebułtowicz
- Department of Bioanalysis and Drugs Analysis, Faculty of Pharmacy, Medical University of Warsaw, 1 Banacha, 02-097 Warsaw, Poland;
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Reszke R, Kiliś-Pstrusińska K, Szepietowski JC. Chronic Kidney Disease-Associated Itch (CKD-aI) in Children-A Narrative Review. Toxins (Basel) 2021; 13:450. [PMID: 34209560 DOI: 10.3390/toxins13070450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic kidney disease (CKD) is a condition of widespread epidemiology and serious consequences affecting all organs of the organism and associated with significant mortality. The knowledge on CKD is rapidly evolving, especially concerning adults. Recently, more data is also appearing regarding CKD in children. Chronic itch (CI) is a common symptom appearing due to various underlying dermatological and systemic conditions. CI may also appear in association with CKD and is termed chronic kidney disease-associated itch (CKD-aI). CKD-aI is relatively well-described in the literature concerning adults, yet it also affects children. Unfortunately, the data on paediatric CKD-aI is particularly scarce. This narrative review aims to describe various aspects of CKD-aI with an emphasis on children, based on the available data in this population and the data extrapolated from adults. Its pathogenesis is described in details, focusing on the growing role of uraemic toxins (UTs), as well as immune dysfunction, altered opioid transmission, infectious agents, xerosis, neuropathy and dialysis-associated aspects. Moreover, epidemiological and clinical aspects are reviewed based on the few data on CKD-aI in children, whereas treatment recommendations are proposed as well, based on the literature on CKD-aI in adults and own experience in managing CI in children.
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Abstract
Chronic kidney disease (CKD) is characterized by the retention of a myriad of solutes termed uraemic (or uremic) toxins, which inflict damage to several organs, including the cardiovascular system. Uraemic toxins can induce hallmarks of cardiovascular disease (CVD), such as atherothrombosis, heart failure, dysrhythmias, vessel calcification and dysregulated angiogenesis. CVD is an important driver of mortality in patients with CKD; however, reliance on conventional approaches to managing CVD risk is insufficient in these patients, underscoring a need to target risk factors that are specific to CKD. Mounting evidence suggests that targeting uraemic toxins and/or pathways induced by uraemic toxins, including tryptophan metabolites and trimethylamine N-oxide (TMAO), can lower the risk of CVD in patients with CKD. Although tangible therapies resulting from our growing knowledge of uraemic toxicity are yet to materialize, a number of pharmacological and non-pharmacological approaches have the potential to abrogate the effects of uraemic toxins, for example, by decreasing the production of uraemic toxins, by modifying metabolic pathways induced by uraemic toxins such as those controlled by aryl hydrocarbon receptor signalling and by augmenting the clearance of uraemic toxins.
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Affiliation(s)
- Jonathan D Ravid
- School of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Mohamed Hassan Kamel
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Vipul C Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. .,Boston Veterans Affairs Healthcare System, Boston, MA, USA. .,Global Co-creation Lab, Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Cheddani L, Haymann JP, Liabeuf S, Tabibzadeh N, Boffa JJ, Letavernier E, Essig M, Drüeke TB, Delahousse M, Massy ZA. Less arterial stiffness in kidney transplant recipients than chronic kidney disease patients matched for renal function. Clin Kidney J 2021; 14:1244-1254. [PMID: 34094521 PMCID: PMC8173621 DOI: 10.1093/ckj/sfaa120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Chronic kidney disease is associated with a high cardiovascular risk. Compared with glomerular filtration rate-matched CKD patients (CKDps), we previously reported a 2.7-fold greater risk of global mortality among kidney transplant recipients (KTRs). We then examined aortic stiffness [evaluated by carotid-femoral pulse wave velocity (CF-PWV)] and cardiovascular risk in KTRs compared with CKDps with comparable measured glomerular filtration rate (mGFR). METHODS We analysed CF-PWV in two cohorts: TransplanTest (KTRs) and NephroTest (CKDps). Propensity scores were calculated including six variables: mGFR, age, sex, mean blood pressure (MBP), body mass index (BMI) and heart rate. After propensity score matching, we included 137 KTRs and 226 CKDps. Descriptive data were completed by logistic regression for CF-PWV values higher than the median (>10.6 m/s). RESULTS At 12 months post-transplant, KTRs had significantly lower CF-PWV than CKDps (10.1 versus 11.0 m/s, P = 0.008) despite no difference at 3 months post-transplant (10.5 versus 11.0 m/s, P = 0.242). A lower occurrence of high arterial stiffness was noted among KTRs compared with CKDps (38.0% versus 57.1%, P < 0.001). It was especially associated with lower mGFR, older age, higher BMI, higher MBP, diabetes and higher serum parathyroid hormone levels. After adjustment, the odds ratio for the risk of high arterial stiffness in KTRs was 0.40 (95% confidence interval 0.23-0.68, P < 0.001). CONCLUSIONS Aortic stiffness was significantly less marked in KTRs 1 year post-transplant than in CKDps matched for GFR and other variables. This observation is compatible with the view that the pathogenesis of post-transplant cardiovascular disease differs, at least in part, from that of CKD per se.
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Affiliation(s)
- Lynda Cheddani
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Jean Philippe Haymann
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Sophie Liabeuf
- Service de Pharmacologie Clinique, Centre Hospitalo Universitaire Amiens, Amiens, France
- Laboratoire MP3CV, EA 7517, Université Jules Vernes de Picardie, CURS, Amiens, France
| | - Nahid Tabibzadeh
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Jean-Jacques Boffa
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Service d’Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Tenon, Paris, France
- Sorbonne Université, INSERM, UMR_S 1155, APHP, Hôpital Tenon, Paris, France
| | - Marie Essig
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Tilman B Drüeke
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
| | - Michel Delahousse
- Service de Néphrologie et Transplantation Rénale, Hôpital Foch, Suresnes, France
| | - Ziad A Massy
- Université Paris Saclay (Paris Sud et Versailles Saint Quentin en Yvelines), INSERM U1018, Equipe 5, CESP (Centre de Recherche en Épidémiologie et Santé des Populations), France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris (APHP), Hôpital Ambroise Paré, Boulogne Billancourt, France
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André C, Choukroun G, Bennis Y, Kamel S, Lemaire-Hurtel AS, Masmoudi K, Bodeau S, Liabeuf S. Potential interactions between uremic toxins and drugs: an application in kidney transplant recipients treated with calcineurin inhibitors. Nephrol Dial Transplant 2021; 37:2284-2292. [PMID: 33783543 PMCID: PMC9585468 DOI: 10.1093/ndt/gfab114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 01/12/2023] Open
Abstract
Background The uraemic toxins that accumulate as renal function deteriorates can potentially affect drug pharmacokinetics. This study’s objective was to determine whether plasma concentrations of certain uraemic toxins are correlated with blood concentrations of two immunosuppressants. Methods DRUGTOX was a cross-sectional study of 403 adult patients followed up after kidney transplantation and who had undergone therapeutic drug monitoring (TDM) of calcineurin inhibitors (tacrolimus or cyclosporin) between August 2019 and March 2020. For each patient, immunosuppressant trough concentrations (C0) were measured in whole blood samples and then normalized against the total daily dose (C0:D ratio). The sample was assayed for five uraemic toxins [urea, trimethylamine N-oxide (TMAO), indole acetic acid (IAA), p-cresylsulphate (PCS) and indoxylsulphate (IxS)] using liquid chromatography–tandem mass spectrometry. Results The median age was 56 years [interquartile range (IQR) 48–66] and the median estimated glomerular filtration rate was 41 mL/min/1.73 m2 (IQR 30–57). Age, sex, body mass index (BMI), urea, IxS and PCS were significantly associated with an increment in the tacrolimus C0:D ratio. A multivariate analysis revealed an independent association with IxS [odds ratio 1.36 (95% confidence interval 1.00–1.85)] after adjustment for sex, age and BMI, whereas adjustment for age weakened the association for PCS and urea. In a univariate logistic analysis, age, sex, BMI and the TMAO level (but not PCS, IxS, IAA or urea) were significantly associated with an increment in the cyclosporine C0:D ratio. Conclusions Even though TDM and dose adaptation of immunosuppressants keep levels within the therapeutic window, increased exposure to tacrolimus (but not cyclosporine) is associated with an accumulation of PCS, IxS and urea.
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Affiliation(s)
- Camille André
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France
| | - Gabriel Choukroun
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Nephrology Dialysis and Transplantation, Amiens University Medical Center, F-80000 Amiens, France
| | - Youssef Bennis
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France
| | - Said Kamel
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Biochemistry, Amiens University Medical Center, F-80000 Amiens, France
| | | | - Kamel Masmoudi
- Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France
| | - Sandra Bodeau
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France
| | - Sophie Liabeuf
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, F-80000 Amiens, France.,Department of Clinical Pharmacology, Amiens University Medical Center, F-80000 Amiens, France
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El Amouri A, Snauwaert E, Foulon A, Vande Moortel C, Van Dyck M, Van Hoeck K, Godefroid N, Glorieux G, Van Biesen W, Vande Walle J, Raes A, Eloot S. Dietary Fibre Intake Is Associated with Serum Levels of Uraemic Toxins in Children with Chronic Kidney Disease. Toxins (Basel) 2021; 13:toxins13030225. [PMID: 33808581 PMCID: PMC8003569 DOI: 10.3390/toxins13030225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 12/11/2022] Open
Abstract
Imbalanced colonic microbial metabolism plays a pivotal role in generating protein-bound uraemic toxins (PBUTs), which accumulate with deteriorating kidney function and contribute to the uraemic burden of children with chronic kidney disease (CKD). Dietary choices impact the gut microbiome and metabolism. The aim of this study was to investigate the relation between dietary fibre and gut-derived PBUTs in paediatric CKD. Sixty-one (44 male) CKD children (9 ± 5 years) were prospectively followed for two years. Dietary fibre intake was evaluated by either 24-h recalls (73%) or 3-day food records (27%) at the same time of blood sampling for assessment of total and free serum levels of different PBUTs using liquid chromatography. We used linear mixed models to assess associations between fibre intake and PBUT levels. We found an inverse association between increase in fibre consumption (g/day) and serum concentrations of free indoxyl sulfate (−3.1% (−5.9%; −0.3%) (p = 0.035)), free p-cresyl sulfate (−2.5% (−4.7%; −0.3%) (p = 0.034)), total indole acetic acid (IAA) (−1.6% (−3.0%; −0.3%) (p = 0.020)), free IAA (−6.6% (−9.3%; −3.7%) (p < 0.001)), total serum p-cresyl glucuronide (pCG) (−3.0% (−5.6%; −0.5%) (p = 0.021)) and free pCG levels (−3.3% (−5.8%; −0.8%) (p = 0.010)). The observed associations between dietary fibre intake and the investigated PBUTs highlight potential benefits of fibre intake for the paediatric CKD population. The present observational findings should inform and guide adaptations of dietary prescriptions in children with CKD.
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Affiliation(s)
- Amina El Amouri
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
- Correspondence:
| | - Evelien Snauwaert
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Aurélie Foulon
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Charlotte Vande Moortel
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Maria Van Dyck
- Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (Campus Gasthuisberg), Herestraat 49, 3000 Leuven, Belgium;
| | - Koen Van Hoeck
- Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium;
| | - Nathalie Godefroid
- Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium;
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
| | - Johan Vande Walle
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Ann Raes
- Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (E.S.); (J.V.W.); (A.R.)
| | - Sunny Eloot
- Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; (A.F.); (C.V.M.); (G.G.); (W.V.B.); (S.E.)
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Cheddani L, Liabeuf S, Essig M, Snanoudj R, Jacquelinet C, Kerleau C, Metzger M, Balkau B, Drüeke TB, Hourmant M, Massy ZA. Higher mortality risk among kidney transplant recipients than among estimated glomerular filtration rate-matched patients with CKD-preliminary results. Nephrol Dial Transplant 2021; 36:176-184. [PMID: 32162656 DOI: 10.1093/ndt/gfaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although kidney transplantation prolongs survival relative to dialysis, it is associated with a higher death rate than in the general population. The objective of the present study was to assess and compare the risk of mortality and frequency of non-lethal cardiovascular (CV) events in kidney transplant recipients (KTRs) beyond 1 year after successful transplantation versus patients with chronic kidney disease (CKD) using propensity score-matched analysis of estimated glomerular filtration rate (eGFR) and other parameters. METHODS After propensity score matching, we studied 340 KTRs from the French Données Informatisées et Validées en Transplantation cohort and 605 non-transplant patients with CKD (CKDps) from the French Chronic Kidney Disease-Renal Epidemiology and Information Network cohort. The mean ± standard deviation eGFR was 42 ± 13 and 41 ± 12 mL/min/ 1.73 m2, respectively (P = 0.649). Descriptive data were completed by a survival analysis with Cox regression models. RESULTS After a median follow-up period of 2.8 years (KTRs 2.0 years, CKDp 2.9 years), 71 deaths were recorded (31 and 40 in the KTR and CKD groups, respectively). Univariate analysis showed that KTRs had a significantly greater risk of mortality than CKDps. In multivariable analysis, KTRs were found to have a 2.7-fold greater risk of mortality [hazard ratio 2.7 (95% confidence interval 1.6-4.7); P = 0.005]. There was no between-group difference concerning the risk of CV events (P = 0.448). CV death rates in KTRs (29.0%) approximated those of CKDps (22.5%), whereas death rates due to infections were higher in KTRs (19.4% versus 10.0%). CONCLUSION Beyond 1 year after transplantation, KTRs, who possibly had a longer CKD history, had a significantly greater mortality risk than eGFR-matched CKDps. The excess risk was not associated with CV events.
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Affiliation(s)
- Lynda Cheddani
- Division of Nephrology, Ambroise Paré University Medical Center, APHP, Boulogne Billancourt, F-92100 Paris, France.,Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
| | - Sophie Liabeuf
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France.,Division of Clinical Pharmacology, Clinical Research Department, Amiens University Medical Center, F-80054 Amiens, France.,EA 7517, MP3CV Laboratory, CURS, Jules Verne University of Picardie, F-80054 Amiens, France
| | - Marie Essig
- Division of Nephrology, Ambroise Paré University Medical Center, APHP, Boulogne Billancourt, F-92100 Paris, France
| | - Renaud Snanoudj
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France.,Division of Nephrology, Hôpital Foch, F-92150 Suresnes, France
| | - Christian Jacquelinet
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
| | - Clarisse Kerleau
- Division of Nephrology, Institut de Transplantation Urologie Néphrologie, Nantes University Medical Center, F-44000 Nantes, France
| | - Marie Metzger
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
| | - Beverley Balkau
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
| | - Tilman B Drüeke
- Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
| | - Maryvonne Hourmant
- Division of Nephrology, Institut de Transplantation Urologie Néphrologie, Nantes University Medical Center, F-44000 Nantes, France
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Medical Center, APHP, Boulogne Billancourt, F-92100 Paris, France.,Institut National de la Santé et de la Recherche Médicale U1018, Team 5, Centre de Recherche en Épidémiologie et Santé des Populations, Paris-Saclay University, Paris-Sud University and Paris Ouest-Versailles-Saint-Quentin-en-Yvelines University, F-94800 Villejuif, France
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12
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Wojtaszek E, Oldakowska-Jedynak U, Kwiatkowska M, Glogowski T, Malyszko J. Uremic Toxins, Oxidative Stress, Atherosclerosis in Chronic Kidney Disease, and Kidney Transplantation. Oxid Med Cell Longev 2021; 2021:6651367. [PMID: 33628373 DOI: 10.1155/2021/6651367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
Patients with chronic kidney disease (CKD) are at a high risk for cardiovascular disease (CVD), and approximately half of all deaths among patients with CKD are a direct result of CVD. The premature cardiovascular disease extends from mild to moderate CKD stages, and the severity of CVD and the risk of death increase with a decline in kidney function. Successful kidney transplantation significantly decreases the risk of death relative to long-term dialysis treatment; nevertheless, the prevalence of CVD remains high and is responsible for approximately 20-35% of mortality in renal transplant recipients. The prevalence of traditional and nontraditional risk factors for CVD is higher in patients with CKD and transplant recipients compared with the general population; however, it can only partly explain the highly increased cardiovascular burden in CKD patients. Nontraditional risk factors, unique to CKD patients, include proteinuria, disturbed calcium, and phosphate metabolism, anemia, fluid overload, and accumulation of uremic toxins. This accumulation of uremic toxins is associated with systemic alterations including inflammation and oxidative stress which are considered crucial in CKD progression and CKD-related CVD. Kidney transplantation can mitigate the impact of some of these nontraditional factors, but they typically persist to some degree following transplantation. Taking into consideration the scarcity of data on uremic waste products, oxidative stress, and their relation to atherosclerosis in renal transplantation, in the review, we discussed the impact of uremic toxins on vascular dysfunction in CKD patients and kidney transplant recipients. Special attention was paid to the role of native and transplanted kidney function.
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Abstract
The uraemic syndrome is a complex clinical picture developing in the advanced stages of chronic kidney disease, resulting in a myriad of complications and a high early mortality. This picture is to a significant extent defined by retention of metabolites and peptides that with a preserved kidney function are excreted or degraded by the kidneys. In as far as those solutes have a negative biological/biochemical impact, they are called uraemic toxins. Here, we describe the historical evolution of the scientific knowledge about uraemic toxins and the role played in this process by the European Uraemic Toxin Work Group (EUTox) during the last two decades. The earliest knowledge about a uraemic toxin goes back to the early 17th century when the existence of what would later be named as urea was recognized. It took about two further centuries to better define the role of urea and its link to kidney failure, and one more century to identify the relevance of post-translational modifications caused by urea such as carbamoylation. The knowledge progressively extended, especially from 1980 on, by the identification of more and more toxins and their adverse biological/biochemical impact. Progress of knowledge was paralleled and impacted by evolution of dialysis strategies. The last two decades, when insights grew exponentially, coincide with the foundation and activity of EUTox. In the final section, we summarize the role and accomplishments of EUTox and the part it is likely to play in future action, which should be organized around focus points like biomarker and potential target identification, intestinal generation, toxicity mechanisms and their correction, kidney and extracorporeal removal, patient-oriented outcomes and toxin characteristics in acute kidney injury and transplantation.
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Affiliation(s)
- Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | - Angel Argilés
- RD-Néphrologie, Montpellier, France.,Néphrologie Dialyse St Guilhem, Sète, France
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research, University Hospital, RWTH Aachen, Aachen, Germany.,School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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14
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te Linde E, van Roij CJ, Meijers BK, De Loor H, Kessels RP, Wetzels JF. Cognitive Function and Uremic Toxins after Kidney Transplantation: An Exploratory Study. Kidney360 2020; 1:1398-1406. [PMID: 35372897 PMCID: PMC8815524 DOI: 10.34067/kid.0000272020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/18/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cognitive functions are altered in patients with CKD. However, it is suggested that cognitive functions improve after kidney transplantation, at least partially. A possible cause for this improvement could be the reduction of uremic retention solutes after transplantation. This study assessed the association between the changes in uremic toxin concentration with the changes in cognitive function in patients after kidney transplantation. METHODS Ten recipients of kidney transplants were compared with 18 controls (nine patients on hemodialysis, and nine patients with CKD stage 4 or 5 [eGFR <30 ml/min per 1.73 m2] who were not on dialysis). An extensive neuropsychological assessment, covering the five major cognitive domains (i.e., memory, attention and concentration, information processing speed, abstract reasoning, and executive function), was done before transplantation, at 1 week post-transplant, and 3 months after transplantation. Similarly, assessments of the 18 matched, control patients were performed longitudinally over a period of 3-5 months. Concentrations of 16 uremic retention solutes (indoxyl glucuronide, p-cresyl glucuronide, phenylglucuronide, 3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid, indoxyl sulfate, p-cresyl sulfate, hippuric acid, phenyl sulfate, kynurenine, tryptophan, kynurenic acid, tyrosine, indole-3-acetic acid, phenylalanine, trimethylamine N-oxide, and phenylacetylglutamine) were measured in serum samples collected at the time of the neuropsychological assessments. RESULTS A significant improvement in cognitive function was only found in the processing-speed domain, and this was observed in both patients who received a transplant and patients with CKD. No significant differences between patients who received a transplant and the control groups were seen in the other cognitive domains. As expected, the serum concentration of most uremic toxins decreased significantly within 1 week after kidney transplantation. CONCLUSIONS There was no significant improvement in cognitive function that could be specifically related to kidney transplantation in the first 3 months after the procedure. These data do not support the notion that uremic toxins exert an immediate effect on cognitive function.
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Affiliation(s)
- Elsemieke te Linde
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claudette J.M. van Roij
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bjӧrn K.I. Meijers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Leuven, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Henriette De Loor
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Leuven, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Roy P.C. Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jack F.M. Wetzels
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Batteux B, Bodeau S, André C, Hurtel-Lemaire AS, Gras-Champel V, Desailly-Henry I, Masmoudi K, Bennis Y, Massy ZA, Kamel S, Choukroun G, Liabeuf S. Association between Uremic Toxin Concentrations and Bone Mineral Density after Kidney Transplantation. Toxins (Basel) 2020; 12:E715. [PMID: 33202788 DOI: 10.3390/toxins12110715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Although uremic osteoporosis is a component of mineral and bone disorder in chronic kidney disease, uremic toxin (UT) concentrations in patients with end-stage kidney disease and bone mineral density (BMD) changes after kidney transplantation have not previously been described. We hypothesized that elevated UT concentrations at the time of transplantation could have a negative impact on bone during the early post-transplantation period. Hence, we sought to determine whether concentrations of UTs (trimethylamine-N-oxide, indoxylsulfate, p-cresylsulfate, p-cresylglucuronide, indole-3-acetic acid, hippuric acid, and 3-carboxy-4-methyl-5-propyl-furanpropionic acid) upon transplantation are predictive markers for (i) osteoporosis one month after transplantation, and (ii) a BMD decrease and the occurrence of fractures 12 and 24 months after kidney transplantation. Between 2012 and 2018, 310 kidney transplant recipients were included, and dual-energy X-ray absorptiometry was performed 1, 12, and 24 months after transplantation. The UT concentrations upon transplantation were determined by reverse-phase high-performance liquid chromatography. Indoxylsulfate concentrations upon transplantation were positively correlated with BMD one month after transplantation for the femoral neck but were not associated with osteoporosis status upon transplantation. Concentrations of the other UTs upon transplantation were not associated with osteoporosis or BMD one month after transplantation. None of the UT concentrations were associated with BMD changes and the occurrence of osteoporotic fractures 12 and 24 months after transplantation. Hence, UT concentrations at the time of kidney transplantation were not predictive markers of osteoporosis or fractures.
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16
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Cheng TH, Ma MC, Liao MT, Zheng CM, Lu KC, Liao CH, Hou YC, Liu WC, Lu CL. Indoxyl Sulfate, a Tubular Toxin, Contributes to the Development of Chronic Kidney Disease. Toxins (Basel) 2020; 12:E684. [PMID: 33138205 PMCID: PMC7693919 DOI: 10.3390/toxins12110684] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/22/2022] Open
Abstract
Indoxyl sulfate (IS), a uremic toxin, causes chronic kidney disease (CKD) progression via its tubulotoxicity. After cellular uptake, IS directly induces apoptotic and necrotic cell death of tubular cells. Additionally, IS increases oxidative stress and decreases antioxidant capacity, which are associated with tubulointerstitial injury. Injured tubular cells are a major source of transforming growth factor-β1 (TGF-β1), which induces myofibroblast transition from residual renal cells in damaged kidney, recruits inflammatory cells and thereby promotes extracellular matrix deposition in renal fibrosis. Moreover, IS upregulates signal transducers and activators of transcription 3 phosphorylation, followed by increases in TGF-β1, monocyte chemotactic protein-1 and α-smooth muscle actin production, which participate in interstitial inflammation, renal fibrosis and, consequently, CKD progression. Clinically, higher serum IS levels are independently associated with renal function decline and predict all-cause mortality in CKD. The poor removal of serum IS in conventional hemodialysis is also significantly associated with all-cause mortality and heart failure incidence in end-stage renal disease patients. Scavenging the IS precursor by AST-120 can markedly reduce tubular IS staining that attenuates renal tubular injury, ameliorates IS-induced oxidative stress and rescues antioxidant glutathione activity in tubular epithelial cells, thereby providing a protective role against tubular injury and ultimately retarding renal function decline.
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Affiliation(s)
- Tong-Hong Cheng
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan; (T.-H.C.); (M.-C.M.); (C.-H.L.); (Y.-C.H.)
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan
| | - Ming-Chieh Ma
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan; (T.-H.C.); (M.-C.M.); (C.-H.L.); (Y.-C.H.)
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325, Taiwan;
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei 235, Taiwan
- Taipei Medical University-Research Center of Urology and Kidney, Taipei Medical University, Taipei 110, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan;
| | - Chun-Hou Liao
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan; (T.-H.C.); (M.-C.M.); (C.-H.L.); (Y.-C.H.)
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei 23148, Taiwan
| | - Yi-Chou Hou
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan; (T.-H.C.); (M.-C.M.); (C.-H.L.); (Y.-C.H.)
- Division of Nephrology, Department of Medicine, Cardinal-Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei 234, Taiwan
| | - Wen-Chih Liu
- Division of Nephrology, Department of Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei 242, Taiwan;
| | - Chien-Lin Lu
- School of Medicine, Fu Jen Catholic University, New Taipei 242, Taiwan; (T.-H.C.); (M.-C.M.); (C.-H.L.); (Y.-C.H.)
- Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei 242, Taiwan
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17
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Heaney LM. Applying mass spectrometry-based assays to explore gut microbial metabolism and associations with disease. ACTA ACUST UNITED AC 2020; 58:719-32. [DOI: 10.1515/cclm-2019-0974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/06/2019] [Indexed: 12/14/2022]
Abstract
AbstractThe workings of the gut microbiome have gained increasing interest in recent years through the mounting evidence that the microbiota plays an influential role in human health and disease. A principal focus of this research seeks to further understand the production of metabolic by-products produced by bacteria resident in the gut, and the subsequent interaction of these metabolites on host physiology and pathophysiology of disease. Gut bacterial metabolites of interest are predominately formed via metabolic breakdown of dietary compounds including choline and ʟ-carnitine (trimethylamine N-oxide), amino acids (phenol- and indole-containing uremic toxins) and non-digestible dietary fibers (short-chain fatty acids). Investigations have been accelerated through the application of mass spectrometry (MS)-based assays to quantitatively assess the concentration of these metabolites in laboratory- and animal-based experiments, as well as for direct circulating measurements in clinical research populations. This review seeks to explore the impact of these metabolites on disease, as well as to introduce the application of MS for those less accustomed to its use as a clinical tool, highlighting pertinent research related to its use for measurements of gut bacteria-mediated metabolites to further understand their associations with disease.
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18
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Liabeuf S, Laville SM, Glorieux G, Cheddani L, Brazier F, Titeca Beauport D, Valholder R, Choukroun G, Massy ZA. Difference in Profiles of the Gut-Derived Tryptophan Metabolite Indole Acetic Acid between Transplanted and Non-Transplanted Patients with Chronic Kidney Disease. Int J Mol Sci 2020; 21:E2031. [PMID: 32188143 DOI: 10.3390/ijms21062031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/04/2020] [Accepted: 03/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Uremic toxins have emerged as potential mediators of morbidity and mortality in patients with chronic kidney disease (CKD). Indole-3-acetic acid (IAA, a tryptophan-derived uremic toxin) might be a useful biomarker in patients with CKD. The objectives of the present study were to (i) describe IAA concentrations in a cohort of non-transplanted patients with CKD and a cohort of transplanted patients with CKD, and (ii) investigate the possible relationship between IAA levels and adverse outcomes in the two cohorts. METHODS Levels of free and total IAA were assayed in the two prospective CKD cohorts (140 non-transplanted patients and 311 transplanted patients). Cox multivariate analyses were used to evaluate the association between IAA levels and outcomes (mortality, cardiovascular events, and graft loss). RESULTS In the non-transplanted CKD cohort, free and total IAA increased progressively with the CKD stage. In the transplanted CKD cohort, free and total IAA levels were elevated at the time of transplantation but had fallen substantially at one-month post-transplantation. Indole acetic acid concentrations were lower in transplanted patients than non-dialysis non-transplanted patients matched for estimated glomerular filtration rate (eGFR), age, and sex. After adjustment for multiple confounders, the free IAA level predicted overall mortality and cardiovascular events in the non-transplanted CKD cohort (hazard ratio [95% confidence interval]: 2.5 [1.2-5.1] and 2.5 [1.3-4.8], respectively). In the transplanted CKD cohort, however, no associations were found between free or total IAA on one hand, and mortality, CV event, or graft survival on the other. CONCLUSION We demonstrated that levels of IAA increase with the CKD stage, and fall substantially, even normalizing, after kidney transplantation. Free IAA appears to be a valuable outcome-associated biomarker in non-transplanted patients, but-at least in our study setting-not in transplanted patients.
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19
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Wang W, Hao G, Pan Y, Ma S, Yang T, Shi P, Zhu Q, Xie Y, Ma S, Zhang Q, Ruan H, Ding F. Serum indoxyl sulfate is associated with mortality in hospital-acquired acute kidney injury: a prospective cohort study. BMC Nephrol 2019; 20:57. [PMID: 30764800 PMCID: PMC6376694 DOI: 10.1186/s12882-019-1238-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/29/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Protein-bound uremic toxins are associated with poor outcomes in patients with chronic kidney disease. The aim of this study is to investigate the relationship between indoxyl sulfate (IS), a protein-bound solute, and 90-day mortality in patients with acute kidney injury. METHODS Adults with hospital-acquired AKI (HA-AKI) were enrolled in this prospective cohort study between 2014 and 2015, according to the KDIGO creatinine criteria. The primary end point was all-cause death during follow-up. RESULTS The mean serum IS level in patients with HA-AKI was 2.74 ± 0.75 μg/ml, which was higher than that in healthy subjects (1.73 ± 0.11 μg/ml, P < 0.001) and critically ill patients (2.46 ± 0.35 μg/ml, P = 0.016) but was lower than that in patients with chronic kidney disease (3.07 ± 0.31 μg/ml, P < 0.001). Furthermore, serum IS levels (2.83 ± 0.55 μg/ml) remained elevated in patients with HA-AKI on the seventh day after AKI diagnosis. Patients with HA-AKI were divided into the following two groups according to the median serum IS level: the low-IS group and the high-IS group. A total of 94 (35.9%) patient deaths occurred within 90 days, including 76 (29.0%) in the low-IS group and 112 (42.7%) in the high-IS group (P = 0.019). Kaplan-Meier analysis revealed that the two groups differed significantly with respect to 90-day survival (log-rank P = 0.007), and Cox regression analysis showed that an IS level ≥ 2.74 μg/ml was significantly associated with a 2.0-fold increased risk of death (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.76 to 4.86; P < 0.001) compared with an IS level < 2.74 μg/ml. CONCLUSIONS Serum IS levels were significantly elevated in patients with HA-AKI compared to those in healthy subjects and critically ill patients and were associated with a worse prognosis of HA-AKI. TRIAL REGISTRATION www.clinicaltrials.gov NCT 00953992. Registered 6 August 2009.
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Affiliation(s)
- Wenji Wang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Guihua Hao
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yu Pan
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Shuai Ma
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Tianye Yang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Peng Shi
- Department of Medical Statistics, Children's Hospital; Center for Evidence-based Medicine, Fudan University, Shanghai, 200433, China
| | - Qiuyu Zhu
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yingxin Xie
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Shaojun Ma
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi Zhang
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Hong Ruan
- Department of Nursing, Clinical Medical School, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Feng Ding
- Division of Nephrology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, 639 Zhizaoju Road, Shanghai, 200011, China.
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20
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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21
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Liabeuf S, Cheddani L, Massy ZA. Uremic Toxins and Clinical Outcomes: The Impact of Kidney Transplantation. Toxins (Basel) 2018; 10:E229. [PMID: 29874852 DOI: 10.3390/toxins10060229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 12/13/2022] Open
Abstract
Non-transplanted and transplanted patients with chronic kidney disease (CKD) differ in terms of mortality and the risk of clinical events. This difference is probably due to the difference of both traditional and non-traditional risk factors. Uremic retention solutes may constitute important non-traditional risk factors in this population. In the present review, we selected a set of uremic toxins that have been associated with harmful effects, and are an appealing target for adjuvant therapy in CKD. For each toxin reviewed here, relevant studies were selected and the relationship with hard clinical outcomes of uremic toxins were compared between non-transplanted CKD patients and transplanted patients taking into account the level of glomerular filtration rate in these two situations.
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Liabeuf S, Villain C, Massy ZA. Protein-bound toxins: has the Cinderella of uraemic toxins turned into a princess? Clin Sci (Lond) 2016; 130:2209-16. [PMID: 27799624 DOI: 10.1042/CS20160393] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/14/2016] [Indexed: 01/29/2023]
Abstract
Chronic kidney disease (CKD) has emerged as a global public health problem. Although the incidence and prevalence of CKD vary from one country to another, the estimated worldwide prevalence is 8-16%. The complications associated with CKD include progression to end-stage renal disease (ESRD), mineral and bone disorders, anaemia, cognitive decline and elevated all-cause and cardiovascular (CV) mortality. As a result of progressive nephron loss, patients with late-stage CKD are permanently exposed to uraemic toxins. These toxins have been classified into three groups as a function of the molecular mass: small water-soluble molecules, middle molecules and protein-bound uraemic toxins. The compounds can also be classified according to their origin (i.e. microbial or not) or their protein-binding ability. The present review will focus on the best-characterized protein-bound uraemic toxins, namely indoxylsulfate (IS), indole acetic acid (IAA) and p-cresylsulfate (PCS, a cresol metabolite). Recent research suggests that these toxins accelerate the progression of CV disease, kidney disease, bone disorders and neurological complications. Lastly, we review therapeutic approaches that can be used to decrease toxin levels.
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Abstract
If chronic kidney disease (CKD) is associated with an impairment of kidney function, several uremic solutes are retained. Some of these exert toxic effects, which are called uremic toxins. p-Cresyl sulfate (pCS) is a prototype protein-bound uremic toxin to which many biological and biochemical (toxic) effects have been attributed. In addition, increased levels of pCS have been associated with worsening outcomes in CKD patients. pCS finds its origin in the intestine where gut bacteria metabolize aromatic amino acids, such as tyrosine and phenylalanine, leading to phenolic end products, of which pCS is one of the components. In this review we summarize the biological effects of pCS and its metabolic origin in the intestine. It appears that, according to in vitro studies, the intestinal bacteria generating phenolic compounds mainly belong to the families Bacteroidaceae, Bifidobacteriaceae, Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Eubacteriaceae, Fusobacteriaceae, Lachnospiraceae, Lactobacillaceae, Porphyromonadaceae, Staphylococcaceae, Ruminococcaceae, and Veillonellaceae. Since pCS remains difficult to remove by dialysis, the gut microbiota could be a future target to decrease pCS levels and its toxicity, even at earlier stages of CKD, aiming at slowing down the progression of the disease and decreasing the cardiovascular burden.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Raymond Vanholder
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Mario Vaneechoutte
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
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Metzinger-Le Meuth V, Burtey S, Maitrias P, Massy ZA, Metzinger L. microRNAs in the pathophysiology of CKD-MBD: Biomarkers and innovative drugs. Biochim Biophys Acta Mol Basis Dis 2016; 1863:337-345. [PMID: 27806914 DOI: 10.1016/j.bbadis.2016.10.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 02/07/2023]
Abstract
microRNAs comprise a novel class of endogenous small non-coding RNAs that have been shown to be implicated in both vascular damage and bone pathophysiology. Chronic kidney disease-mineral bone disorder (CKD-MBD) is characterized by vessel and bone damage secondary to progressive loss of kidney function. In this review, we will describe how several microRNAs have been implicated, in recent years, in cellular and animal models of CKD-MBD, and have been very recently shown to be deregulated in patients with CKD. Particular emphasis has been placed on the endothelial-specific miR-126, a potential biomarker of endothelial dysfunction, and miR-155 and miR-223, which play a role in both vascular smooth muscle cells and osteoclasts, with an impact on the vascular calcification and osteoporosis process. Finally, as these microRNAs may constitute useful targets to prevent or treat complications of CKD-MBD, we will discuss their potential as innovative drugs, describe how they could be delivered in a timely and specific way to vessels and bone by using the most recent techniques such as nanotechnology, viral vectors or CRISPR gene targeting.
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Affiliation(s)
- Valérie Metzinger-Le Meuth
- C.U.R.S, Laboratoire INSERM U1088, Chemin du Thil, Université de Picardie Jules Verne, 80025 Amiens Cedex 1, France; Université Paris 13, Sorbonne Paris Cité, UFR SMBH, 74 rue Marcel Cachin, 93017, Bobigny cedex, France
| | | | - Pierre Maitrias
- C.U.R.S, Laboratoire INSERM U1088, Chemin du Thil, Université de Picardie Jules Verne, 80025 Amiens Cedex 1, France; Department of Cardiovascular Surgery, Amiens University Hospital, France
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, APHP, UVSQ University, INSERM U1018 team5, Paris, France
| | - Laurent Metzinger
- C.U.R.S, Laboratoire INSERM U1088, Chemin du Thil, Université de Picardie Jules Verne, 80025 Amiens Cedex 1, France.
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Brigant B, Metzinger-Le Meuth V, Massy ZA, McKay N, Liabeuf S, Pelletier M, Sallée M, M'Baya-Moutoula E, Paul P, Drueke TB, Burtey S, Metzinger L. Serum microRNAs are altered in various stages of chronic kidney disease: a preliminary study. Clin Kidney J 2016. [PMID: 28643818 PMCID: PMC5469576 DOI: 10.1093/ckj/sfw060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background MicroRNAs (miRNAs) are innovative and informative blood-based biomarkers involved in numerous pathophysiological processes. In this study and based on our previous experimental data, we investigated miR-126, miR-143, miR-145, miR-155 and miR-223 as potential circulating biomarkers for the diagnosis and prognosis of patients with chronic kidney disease (CKD). The primary objective of this study was to assess the levels of miRNA expression at various stages of CKD. Methods RNA was extracted from serum, and RT-qPCR was performed for the five miRNAs and cel-miR-39 (internal control). Results Serum levels of miR-143, -145 and -223 were elevated in patients with CKD compared with healthy controls. They were further increased in chronic haemodialysis patients, but were below control levels in renal transplant recipients. In contrast, circulating levels of miR-126 and miR-155 levels, which were also elevated in CKD patients, were lower in the haemodialysis group and even lower in the transplant group. Four of the five miRNA species were correlated with estimated glomerular filtration rate, and three were correlated with circulating uraemic toxins. Conclusions This exploratory study suggests that specific miRNAs could be biomarkers for complications of CKD, justifying further studies to link changes of miRNA levels with outcomes in CKD patients.
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Affiliation(s)
- Benjamin Brigant
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1088, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires (MP3C), CURS, Université Picardie Jules Verne, Amiens, France
| | - Valérie Metzinger-Le Meuth
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1088, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires (MP3C), CURS, Université Picardie Jules Verne, Amiens, France.,University Paris 13, Sorbonne Paris Cité, UFR SMBH, Bobigny, France
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré Hospital, Paris Ile de France Ouest (UVSQ) University, Boulogne Billancourt, France.,INSERM U1018, Centre de recherche en épidémiologie et santé des populations, Equipe 5, Villejuif, France
| | - Nathalie McKay
- INSERM UMR_S 1076, Aix Marseille Université, INSERM UMR_S 1076, Marseille, France
| | - Sophie Liabeuf
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1088, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires (MP3C), CURS, Université Picardie Jules Verne, Amiens, France
| | - Marion Pelletier
- INSERM UMR_S 1076, Aix Marseille Université, INSERM UMR_S 1076, Marseille, France
| | - Marion Sallée
- INSERM UMR_S 1076, Aix Marseille Université, INSERM UMR_S 1076, Marseille, France
| | - Eléonore M'Baya-Moutoula
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1088, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires (MP3C), CURS, Université Picardie Jules Verne, Amiens, France
| | - Pascale Paul
- INSERM UMR_S 1076, Aix Marseille Université, INSERM UMR_S 1076, Marseille, France
| | - Tilman B Drueke
- INSERM U1018, Centre de recherche en épidémiologie et santé des populations, Equipe 5, Villejuif, France
| | - Stéphane Burtey
- INSERM UMR_S 1076, Aix Marseille Université, INSERM UMR_S 1076, Marseille, France
| | - Laurent Metzinger
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1088, Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires (MP3C), CURS, Université Picardie Jules Verne, Amiens, France
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Vanholder R, Glorieux G, Massy ZA. Intestinal metabolites, chronic kidney disease and renal transplantation: Enigma Variations? Nephrol Dial Transplant 2016; 31:1547-51. [PMID: 27190337 DOI: 10.1093/ndt/gfw040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Griet Glorieux
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Saclay-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France INSERM U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, Villejuif, France
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