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The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials.
J Ren Nutr. 2021 Mar 16 [Online ahead of print]JR

Abstract

OBJECTIVES

The results of previously published meta-analyses showed that dietary fiber could reduce the levels of p-cresyl sulfate, blood urea nitrogen, and creatinine in patients with chronic kidney disease (CKD). However, these results were based on some trials with pre-post design and randomized controlled trials of low quality. Additionally, it has been suggested that the dosage and duration of fiber supplementation and patients' characteristics potentially influence the effect of dietary fiber in reducing uremic toxins, but it would appear that no research has provided reliable evidence.

DESIGN AND METHODS

We searched PubMed, Web of Science, and Cochrane Library. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was quantified by I2. Publication bias was evaluated by Egger's test.

RESULTS

Ten randomized controlled trials involving 292 patients with CKD were identified. Dietary fiber supplementation can significantly reduce the levels of indoxyl sulfate (SMD = -0.55, 95% CI = -1.04, -0.07, P = .03), p-cresyl sulfate (SMD = -0.47, 95% CI = -0.82, -0.13, P < .01), blood urea nitrogen (SMD = -0.31, 95% CI = -0.58, -0.03, P = .03), and uric acid (SMD = -0.60, 95% CI = -1.02, -0.18, P < .01), but not on reducing creatinine (SMD = -0.31, 95% CI = -0.73, 0.11, P = .14). In subgroup analyses, the reduction of indoxyl sulfate was more obvious among patients on dialysis than patients not on dialysis (P for interaction = .03); the reduction of creatinine was more obvious among patients without diabetes than those with diabetes (P for interaction <.01).

CONCLUSIONS

This meta-analysis indicates that dietary fiber supplementation can significantly reduce the levels of uremic toxins in patients with CKD, with evidence for a more obvious effect of patients on dialysis and without diabetes. These findings inform recommendations for using dietary fiber to reducing the uremic toxin among CKD patients in clinical practice.

Authors+Show Affiliations

School of Nursing, Medical College of Soochow University, Suzhou, People's Republic of China.Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.Department of Nephrology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.Department of Adult Nursing and Paramedic Science, University of Greenwich, London, United Kingdom.Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China. Electronic address: sxwang2001@163.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33741249

Citation

Yang, Hui-Li, et al. "The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: a Meta-Analysis of Randomized Controlled Trials." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 2021.
Yang HL, Feng P, Xu Y, et al. The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials. J Ren Nutr. 2021.
Yang, H. L., Feng, P., Xu, Y., Hou, Y. Y., Ojo, O., & Wang, X. H. (2021). The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation. https://doi.org/10.1053/j.jrn.2020.11.008
Yang HL, et al. The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: a Meta-Analysis of Randomized Controlled Trials. J Ren Nutr. 2021 Mar 16; PubMed PMID: 33741249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of Dietary Fiber Supplementation in Regulating Uremic Toxins in Patients With Chronic Kidney Disease: A Meta-Analysis of Randomized Controlled Trials. AU - Yang,Hui-Li, AU - Feng,Ping, AU - Xu,Yi, AU - Hou,Yun-Ying, AU - Ojo,Omorogieva, AU - Wang,Xiao-Hua, Y1 - 2021/03/16/ PY - 2020/08/16/received PY - 2020/11/09/revised PY - 2020/11/22/accepted PY - 2021/3/20/entrez PY - 2021/3/21/pubmed PY - 2021/3/21/medline JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr N2 - OBJECTIVES: The results of previously published meta-analyses showed that dietary fiber could reduce the levels of p-cresyl sulfate, blood urea nitrogen, and creatinine in patients with chronic kidney disease (CKD). However, these results were based on some trials with pre-post design and randomized controlled trials of low quality. Additionally, it has been suggested that the dosage and duration of fiber supplementation and patients' characteristics potentially influence the effect of dietary fiber in reducing uremic toxins, but it would appear that no research has provided reliable evidence. DESIGN AND METHODS: We searched PubMed, Web of Science, and Cochrane Library. Data were pooled by the generic inverse variance method using random effects models and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). Heterogeneity was quantified by I2. Publication bias was evaluated by Egger's test. RESULTS: Ten randomized controlled trials involving 292 patients with CKD were identified. Dietary fiber supplementation can significantly reduce the levels of indoxyl sulfate (SMD = -0.55, 95% CI = -1.04, -0.07, P = .03), p-cresyl sulfate (SMD = -0.47, 95% CI = -0.82, -0.13, P < .01), blood urea nitrogen (SMD = -0.31, 95% CI = -0.58, -0.03, P = .03), and uric acid (SMD = -0.60, 95% CI = -1.02, -0.18, P < .01), but not on reducing creatinine (SMD = -0.31, 95% CI = -0.73, 0.11, P = .14). In subgroup analyses, the reduction of indoxyl sulfate was more obvious among patients on dialysis than patients not on dialysis (P for interaction = .03); the reduction of creatinine was more obvious among patients without diabetes than those with diabetes (P for interaction <.01). CONCLUSIONS: This meta-analysis indicates that dietary fiber supplementation can significantly reduce the levels of uremic toxins in patients with CKD, with evidence for a more obvious effect of patients on dialysis and without diabetes. These findings inform recommendations for using dietary fiber to reducing the uremic toxin among CKD patients in clinical practice. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/33741249/The_Role_of_Dietary_Fiber_Supplementation_in_Regulating_Uremic_Toxins_in_Patients_With_Chronic_Kidney_Disease:_A_Meta_Analysis_of_Randomized_Controlled_Trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(20)30291-0 DB - PRIME DP - Unbound Medicine ER -
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