Aryl hydrocarbon receptor activation in chronic kidney disease: Role of uremic toxins

International audienceThe aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor involved in the expression of xenobiotic-metabolizing enzymes, inflammatory cytokines and adhesion molecules. Uremic toxins such as indoxyl sulfate and indole acetic acid are derived from tryptophan fermentation by gut microbiota; they accumulate in patients with chronic kidney disease (CKD) on haemodialysis and have recently emerged as potent ligands of AhR. Therefore, AhR can serve as a mediator in inflammation and cardiovascular diseases in these patients. This review discusses current data that support a link between AhR activation and uremic toxins from gut microbiota in CKD

Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial

International audienceObjective: The objective of the study was to evaluate the effects of probiotic supplementation on the gut microbiota profile and inflammatory markers in chronic kidney disease patients undergoing maintenance hemodialysis (HD). Design and Methods: This was a randomized, double-blind, placebo-controlled study. Forty-six HD patients were assigned to receive 1 of 2 treatments: probiotic (n = 23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacterialongum, 90 billion colony-forming units per day) or placebo (n = 23) daily for 3 months. Blood and feces were collected at baseline and after intervention. The inflammatory markers (C-reactive protein and interleukin-6) were analyzed by immunoenzymatic assay (enzyme-linked immunosorbent assay). Uremic toxins plasma levels (indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid) were obtained by Reversed-Phase High-Performance Liquid Chromatography. Routine laboratory parameters were measured by standard techniques. Fecal pH was measured by the colorimetric method, and the gut microbiota profile was assessed by Denaturing Gradient Gel Electrophoresis analysis. Results: Sixteen patients remained in the probiotic group (11 men, 53.6 +/- 11.0 year old, 25.3 +/- 4.6 kg/m(2)) and 17 in the placebo group (10 men, 50.3 +/- 8.5 year old, 25.2 +/- 5.7 kg/m(2)). After probiotic supplementation there was a significant increase in serum urea (from 149.6 +/- 34.2 mg/dL to 172.6 +/- 45.0 mg/dL, P = .02), potassium (from 4.4 +/- 0.4 mmol/L to 4.8 +/- 0.4 mmol/L, P = .02), and indoxyl sulfate (from 31.2 +/- 15.9 to 36.5 +/- 15.0 mg/dL, P = .02). The fecal pH was reduced from 7.2 +/- 0.8 to 6.5 +/- 0.5 (P = .01). These parameters did not change significantly in placebo group. Changes in the percentage delta (Delta) between groups were exhibited with no statistical differences observed. The inflammatory markers and gut profile were not altered by supplementation. Conclusions: Aprobiotic supplementation failed to reduce uremic toxins and inflammatory markers. Therefore, probiotic therapy should be chosen with caution in HD patients. Further studies addressing probiotic therapy in chronic kidney disease patients are needed. (C) 2017 by the National Kidney Foundation, Inc. All rights reserved