Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain

Amina El Amouri; Evelien Snauwaert; Aurélie Foulon; Charlotte Vande Moortel; Maria Van Dyck; Koen Van Hoeck; Nathalie Godefroid; Griet Glorieux; Wim Van Biesen; Johan Vande Walle; Ann Raes; Sunny Eloot

doi:10.1007/s00467-020-04840-9

Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain

Amina El Amouri, Evelien Snauwaert, Aurélie Foulon, Charlotte Vande Moortel, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Griet Glorieux, Wim Van Biesen, Johan Vande Walle, Ann Raes, Sunny Eloot

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Abstract

BACKGROUND: Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations.

METHODS: In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA).

RESULTS: In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function.

CONCLUSIONS: Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.

Original language	English
Pages (from-to)	1589-1595
Number of pages	7
Journal	Pediatric Nephrology
Volume	36
Issue number	6
DOIs	https://doi.org/10.1007/s00467-020-04840-9
Publication status	Published - Jun 2021
Externally published	Yes

Bibliographical note

Funding Information:
This study was funded by the Agency for Innovation by Science and Technology (IWT), from the ‘Applied Biomedical Research with a Primary Societal Goal’ (TBM) program in Flanders (Belgium): UToPaed project, grant number IWT-TBM 150195. J.V.W. received lecture fees from Vitaflo and is member of the European Society for Paediatric Nephrology nutritional task force (with Vitaflo grant).

Publisher Copyright:
© 2021, IPNA.

Keywords

Adolescent
Child
Child, Preschool
Cross-Sectional Studies
Dietary Fiber
Humans
Renal Insufficiency, Chronic
Toxins, Biological
Uremia
Uremic Toxins

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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. (2021). Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatric Nephrology, 36(6), 1589-1595. https://doi.org/10.1007/s00467-020-04840-9

@article{b0cd839635cd4d9183a184b28b934c95,

title = "Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain",

abstract = "BACKGROUND: Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations.METHODS: In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA).RESULTS: In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function.CONCLUSIONS: Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.",

keywords = "Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Dietary Fiber, Humans, Renal Insufficiency, Chronic, Toxins, Biological, Uremia, Uremic Toxins",

author = "{El Amouri}, Amina and Evelien Snauwaert and Aur{\'e}lie Foulon and {Vande Moortel}, Charlotte and {Van Dyck}, Maria and {Van Hoeck}, Koen and Nathalie Godefroid and Griet Glorieux and {Van Biesen}, Wim and {Vande Walle}, Johan and Ann Raes and Sunny Eloot",

note = "Funding Information: This study was funded by the Agency for Innovation by Science and Technology (IWT), from the {\textquoteleft}Applied Biomedical Research with a Primary Societal Goal{\textquoteright} (TBM) program in Flanders (Belgium): UToPaed project, grant number IWT-TBM 150195. J.V.W. received lecture fees from Vitaflo and is member of the European Society for Paediatric Nephrology nutritional task force (with Vitaflo grant). Publisher Copyright: {\textcopyright} 2021, IPNA.",

year = "2021",

month = jun,

doi = "10.1007/s00467-020-04840-9",

language = "English",

volume = "36",

pages = "1589--1595",

journal = "Pediatric Nephrology",

issn = "0931-041X",

publisher = "Springer Verlag",

number = "6",

}

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 2021, 'Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain', Pediatric Nephrology, vol. 36, no. 6, pp. 1589-1595. https://doi.org/10.1007/s00467-020-04840-9

TY - JOUR

T1 - Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain

AU - El Amouri, Amina

AU - Snauwaert, Evelien

AU - Foulon, Aurélie

AU - Vande Moortel, Charlotte

AU - Van Dyck, Maria

AU - Van Hoeck, Koen

AU - Godefroid, Nathalie

AU - Glorieux, Griet

AU - Van Biesen, Wim

AU - Vande Walle, Johan

AU - Raes, Ann

AU - Eloot, Sunny

N1 - Funding Information: This study was funded by the Agency for Innovation by Science and Technology (IWT), from the ‘Applied Biomedical Research with a Primary Societal Goal’ (TBM) program in Flanders (Belgium): UToPaed project, grant number IWT-TBM 150195. J.V.W. received lecture fees from Vitaflo and is member of the European Society for Paediatric Nephrology nutritional task force (with Vitaflo grant). Publisher Copyright: © 2021, IPNA.

PY - 2021/6

Y1 - 2021/6

N2 - BACKGROUND: Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations.METHODS: In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA).RESULTS: In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function.CONCLUSIONS: Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.

AB - BACKGROUND: Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations.METHODS: In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA).RESULTS: In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function.CONCLUSIONS: Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.

KW - Adolescent

KW - Child

KW - Child, Preschool

KW - Cross-Sectional Studies

KW - Dietary Fiber

KW - Humans

KW - Renal Insufficiency, Chronic

KW - Toxins, Biological

KW - Uremia

KW - Uremic Toxins

UR - http://www.scopus.com/inward/record.url?scp=85098731276&partnerID=8YFLogxK

U2 - 10.1007/s00467-020-04840-9

DO - 10.1007/s00467-020-04840-9

M3 - Article

C2 - 33387017

SN - 0931-041X

VL - 36

SP - 1589

EP - 1595

JO - Pediatric Nephrology

JF - Pediatric Nephrology

IS - 6

ER -

Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain

Abstract

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