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NDT Advance Access published online on August 19, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp414
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


p-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin

Björn K. I. Meijers1, Vicky De Preter2, Kristin Verbeke2, Yves Vanrenterghem1 and Pieter Evenepoel1

1 Division of Nephrology, Department of Medicine 2 Department of Gastrointestinal Research and Leuven Food Science and Nutrition Research Centre (LFoRCe), University Hospital Leuven, 3000 Leuven, Belgium

Correspondence and offprint requests to: Pieter Evenepoel; E-mail: Pieter.Evenepoel{at}uz.kuleuven.ac.be



  Abstract

Introduction. Protein-bound uraemic retention solutes, including p-cresyl sulfate and indoxyl sulfate, contribute substantially to the uraemic syndrome. These and several other uraemic retention solutes originate from intestinal bacterial protein fermentation. We investigated whether the prebiotic oligofructose-enriched inulin reduced serum concentration of p-cresyl sulfate and indoxyl sulfate, through interference with intestinal generation.

Methods. We performed a single centre, non-randomized, open-label phase I/II study in maintenance HD patients with a 4-week, escalating dose regimen of oligofructose-enriched inulin (ORAFTI®Synergy 1, Tienen, Belgium) (www.clinicaltrials.gov NCT00695513 [ClinicalTrials.gov] ). Changes in p-cresyl sulfate and indoxyl sulfate serum concentrations as well as changes in p-cresyl sulfate and indoxyl sulfate generation rates were analysed.

Results. Compliance with therapy was excellent. p-Cresyl sulfate serum concentrations at 4 weeks were significantly reduced by 20% (intention to treat, P = 0.01; per protocol, P = 0.03). Also p-cresyl sulfate generation rates were reduced (P = 0.007). In contrast, neither indoxyl sulfate generation rates (P = 0.9) nor serum concentrations (P = 0.4) were significantly changed.

Conclusion. The prebiotic oligofructose-inulin significantly reduced p-cresyl sulfate generation rates and serum concentrations in haemodialysis patients. Whether reduction of p-cresyl sulfate serum concentrations, an independent predictor of cardiovascular disease in HD patients, will result in improved cardiovascular outcomes remains to be proven.

Keywords: haemodialysis; indoxyl sulfate; intervention study; p-cresol; prebiotic

Received for publication: 31. 3.09
Accepted in revised form: 22. 7.09


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