PMID- 31942927 OWN - NLM STAT- MEDLINE DCOM- 20200629 LR - 20230214 IS - 1938-3207 (Electronic) IS - 0002-9165 (Linking) VI - 111 IP - 5 DP - 2020 May 1 TI - Inulin-type fructan intervention restricts the increase in gut microbiome-generated indole in patients with peritoneal dialysis: a randomized crossover study. PG - 1087-1099 LID - 10.1093/ajcn/nqz337 [doi] AB - BACKGROUND: Indoxyl sulfate (IS) and p-cresyl sulfate (pCS), 2 important protein-bound uremic toxins, are independent risk factors for cardiovascular disease in patients with end-stage renal disease. Indole and p-cresol are gut microbiome-generated precursors of IS and pCS. OBJECTIVE: The aim of the present study was to determine whether inulin-type fructans (ITFs) reduce the production of indole and p-cresol by altering their producing bacteria in patients with peritoneal dialysis. METHODS: Patients receiving peritoneal dialysis for >3 mo without diabetes and not using antibiotics were recruited to a randomized, double-blind, placebo-controlled, crossover trial of ITF intervention over 36 wk (12-wk washout). The primary outcomes were gut microbiome, fecal indole and p-cresol, indole-producing bacteria, p-cresol-producing bacteria, and serum IS and pCS. The secondary outcomes were fecal pH, 24-h urine, and dialysis removal of IS and pCS. RESULTS: Of 21 individuals randomly assigned, 15 completed the study. The daily nutrient intakes, including protein, tryptophan, and tyrosine, were isostatic during the prebiotic, washout, and placebo intervention. There were no baseline differences in the outcomes of interest between treatments. For fecal indole, its concentrations did not change significantly in either treatment. However, there was a trend toward the treatment-by-time effect (P = 0.052), with a quantitative reduction in the ITF treatment and an increase in the control. The difference in the changes between the 2 treatments was significant (-10.07 +/- 7.48 mug/g vs +13.35 +/- 7.66 mug/g; P = 0.040). Similar to Bacteroides thetaiotaomicron, there was a difference over time between the 2 treatments, with a significant treatment and time interaction effect (P = 0.047). There were no treatment, time, or interaction effects for fecal p-cresol, serum IS and pCS, 24-h urine, and dialysis removal of IS and pCS. CONCLUSIONS: Our results suggested that ITFs restricted the increase in gut microbiome-generated indole in patients with peritoneal dialysis. This trial was registered at http://www.chictr.org.cn/showproj.aspx?proj=21228 as ChiCTR-INR-17013739. CI - Copyright (c) The Author(s) 2020. FAU - Li, Li AU - Li L AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Xiong, Qingqing AU - Xiong Q AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Zhao, Jing AU - Zhao J AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Lin, Xuechun AU - Lin X AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - He, Shuiqin AU - He S AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Wu, Nannan AU - Wu N AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Yao, Ying AU - Yao Y AD - Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. AD - Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Liang, Wangqun AU - Liang W AD - Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Zuo, Xuezhi AU - Zuo X AD - Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Ying, Chenjiang AU - Ying C AD - Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. LA - eng PT - Journal Article PT - Randomized Controlled Trial PT - Research Support, Non-U.S. Gov't PL - United States TA - Am J Clin Nutr JT - The American journal of clinical nutrition JID - 0376027 RN - 0 (Cresols) RN - 0 (Indoles) RN - 0 (Prebiotics) RN - 8724FJW4M5 (indole) RN - 9005-80-5 (Inulin) RN - GF3CGH8D7Z (cresol) SB - IM CIN - Am J Clin Nutr. 2020 May 1;111(5):948-949. PMID: 32219425 EIN - Am J Clin Nutr. 2022 Jun 7;115(6):1659. PMID: 35667659 MH - Adult MH - Aged MH - Bacteria/classification/genetics/isolation & purification/metabolism MH - Cresols MH - Cross-Over Studies MH - Feces/microbiology MH - Female MH - Gastrointestinal Microbiome/*drug effects MH - Humans MH - Indoles/*metabolism MH - Inulin/*administration & dosage MH - Kidney Failure, Chronic/*drug therapy/*microbiology/therapy MH - Male MH - Middle Aged MH - Peritoneal Dialysis MH - Prebiotics/*administration & dosage OTO - NOTNLM OT - p-cresol OT - gut microbiome OT - indole OT - inulin-type fructans OT - peritoneal dialysis OT - prebiotics EDAT- 2020/01/17 06:00 MHDA- 2020/07/01 06:00 CRDT- 2020/01/17 06:00 PHST- 2019/07/08 00:00 [received] PHST- 2019/12/17 00:00 [accepted] PHST- 2020/01/17 06:00 [pubmed] PHST- 2020/07/01 06:00 [medline] PHST- 2020/01/17 06:00 [entrez] AID - S0002-9165(23)00544-0 [pii] AID - 10.1093/ajcn/nqz337 [doi] PST - ppublish SO - Am J Clin Nutr. 2020 May 1;111(5):1087-1099. doi: 10.1093/ajcn/nqz337.