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Nutrients 2017, 9(5), 489; doi:10.3390/nu9050489

Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease

Raul Fernandez-Prado, IIS-Fundación Jiménez Díaz-Universidad Autónoma de Madrid, 28040 Madrid, Spain
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Received: 14 March 2017 / Revised: 22 April 2017 / Accepted: 9 May 2017 / Published: 12 May 2017
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
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Abstract

In chronic kidney disease (CKD), accumulation of uremic toxins is associated with an increased risk of death. Some uremic toxins are ingested with the diet, such as phosphate and star fruit-derived caramboxin. Others result from nutrient processing by gut microbiota, yielding precursors of uremic toxins or uremic toxins themselves. These nutrients include l-carnitine, choline/phosphatidylcholine, tryptophan and tyrosine, which are also sold over-the-counter as nutritional supplements. Physicians and patients alike should be aware that, in CKD patients, the use of these supplements may lead to potentially toxic effects. Unfortunately, most patients with CKD are not aware of their condition. Some of the dietary components may modify the gut microbiota, increasing the number of bacteria that process them to yield uremic toxins, such as trimethylamine N-Oxide (TMAO), p-cresyl sulfate, indoxyl sulfate and indole-3 acetic acid. Circulating levels of nutrient-derived uremic toxins are associated to increased risk of death and cardiovascular disease and there is evidence that this association may be causal. Future developments may include maneuvers to modify gut processing or absorption of these nutrients or derivatives to improve CKD patient outcomes. View Full-Text
Keywords: chronic kidney disease; caramboxin; microbiota; choline; carnitine; tryptophan; tyrosine; trimethylamine N-Oxide (TMAO); p-cresyl sulfate; indoxyl sulfate; gut–kidney axis chronic kidney disease; caramboxin; microbiota; choline; carnitine; tryptophan; tyrosine; trimethylamine N-Oxide (TMAO); p-cresyl sulfate; indoxyl sulfate; gut–kidney axis
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Fernandez-Prado, R.; Esteras, R.; Perez-Gomez, M.V.; Gracia-Iguacel, C.; Gonzalez-Parra, E.; Sanz, A.B.; Ortiz, A.; Sanchez-Niño, M.D. Nutrients Turned into Toxins: Microbiota Modulation of Nutrient Properties in Chronic Kidney Disease. Nutrients 2017, 9, 489.

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