Abstract | PURPOSE OF REVIEW: RECENT FINDINGS: Studies have emerged that support the concept of intestinal dialysis, such as colonic perfusion with a Malone antegrade continence enema stoma or colonic irrigation with a rectal catheter, as a promising adjuvant approach to control uremia in CKD, although most findings are preliminary. The use of AST-120, an oral adsorbent, has been shown to reduce circulating levels of indoxyl sulfate and p-cresol sulfate and have potential renoprotective benefits in patients with advanced CKD. Diarrhea or inducing watery stools may modulate fluid retention and potassium and phosphorus load. Accumulating evidence indicates that plant-based diets, low-protein diets, and pre-, pro-, and synbiotic supplementation may lead to favorable alterations of the gut microbiota, contributing to reduce uremic toxin generation. The effects of these gut-targeted interventions on kidney and cardiovascular outcomes are still limited and need to be tested in future studies including clinical trials. SUMMARY: Interventions aimed at enhancing bowel elimination of uremic toxins, fluid and electrolytes and at modulating gut microbiota may represent novel therapeutic strategies for the management of uremia in patients with CKD.
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Authors | Keiichi Sumida, Wei Ling Lau, Kamyar Kalantar-Zadeh, Csaba P Kovesdy |
Journal | Current opinion in nephrology and hypertension
(Curr Opin Nephrol Hypertens)
Vol. 31
Issue 1
Pg. 82-91
(01 01 2022)
ISSN: 1473-6543 [Electronic] England |
PMID | 34846313
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Review)
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Copyright | Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved. |
Chemical References |
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Topics |
- Gastrointestinal Microbiome
- Humans
- Microbiota
- Renal Dialysis
(adverse effects)
- Renal Insufficiency, Chronic
(therapy)
- Uremia
(therapy)
- Uremic Toxins
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