Diet, gut microbiome and indoxyl sulphate in chronic kidney disease patients: Dietary management in CKD patients

Emerging evidence suggests that intestinal dysbiosis plays an important role in host inflammation locally and systemically. Such pathological condition is even more prevailing in patients with chronic kidney disease (CKD). Of note, indoxyl sulphate (IS), a gut-derived uremic toxin, is notorious for its pro-inflammatory feature in CKD patients. IS accumulates in the body as the urinary excretion of uremic toxins is impaired, and further worsens the kidney function in a vicious cycle to CKD. Dietary restriction in vegetables, fruits and yogurt leads to the predominance of indole-producing intestinal microbial flora and further exaggerates the accumulation of IS in CKD patients. Recently, interventional studies have shown that circulating IS can be reduced by dietary prebiotic and/or probiotic supplements. However, further randomized controlled trials are warranted to examine whether such beneficial effect of dietary prebiotic/probiotic supplements could be extrapolated to better hard outcomes in CKD population. In this review, we would also like to emphasize the importance of achieving sufficient intake of dietary fibre by proper vegetable pre-treatment and accurate fruit selection, instead of directly avoiding these potassium-rich yet fibre-rich and base-producing foods. Summary at a Glance The accumulation of indoxyl sulphate, a gut-derived uremic toxin which is notorious for its pro-inflammatory feature, in CKD patients is exaggerated by the dietary restriction on vegetables, fruits, and yogurt, which leads to the predominance of indole-producing intestinal microbial flora. Thus in order to establish gut symbiosis in CKD patients, it's important to achieve sufficient intake of dietary fiber by proper vegetable pretreatment and accurate fruit selection, instead of directly avoiding these potassium-rich yet fiber-rich and base-producing foods.