Nutrition Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil.
Hospital do Rim - Fundação Oswaldo Ramos, São Paulo, Brazil; Division of Nephrology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
J Ren Nutr. 2020 Jan;30(1):31-35. doi: 10.1053/j.jrn.2019.02.004. Epub 2019 Apr 5.
The aim of this study is to evaluate the association between bowel habits and microbial-derived uremic toxins p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD).
This is a cross-sectional analysis including 43 nondiabetic NDD-CKD patients (58% men; 59.0 ± 13.5 years; estimated glomerular filtration rate, 21.3 ± 7.9 mL/min/1.73 m). Bowel habit was assessed by the Bristol Stool Scale (BSS <3, characterized by hard consistency of stools and/or low frequency of evacuation and BSS ≥3, representing a more regular bowel habit) and by the Rome III criteria. PCS and IS (serum, free and total; urinary, total) were determined by high-performance liquid chromatography. Dietary intake was assessed by the 3-day food records.
The frequency of constipation assessed by BSS and Rome III criteria was 33% (n = 14/43) and 35% (n = 15/43), respectively. The BSS <3 exhibited higher PCS, independent of renal function and dietary protein-fiber ratio (β [95% confidence interval {CI}]: serum, total PCS = 1.54 [1.06-2.23], P = .02; serum free PCS = 1.40 [1.00-1.97], P = .05; urinary PCS = 1.78 [1.10-2.90], P < .02). According to the Rome III criteria, a tendency for a higher serum total PCS (β [95% CI]: 1.39 [0.95-2.03 μmol/L], P = .09) and a significantly higher urinary PCS (β [95% CI]: 1.80 [1.11-2.94 μmol/24 h], P = .02) was found in constipated participants. No effect of a compromised bowel habit (Rome III criteria or BSS) was found on IS.
Constipation may lead to production of PCS in nondiabetic NDD-CKD patients.
本研究旨在评估非透析依赖性慢性肾脏病（NDD-CKD）患者的肠道习惯与微生物衍生的尿毒症毒素对甲酚硫酸酯（PCS）和吲哚硫酸酯（IS）之间的关联。
这是一项横断面分析，共纳入 43 例非糖尿病 NDD-CKD 患者（58%为男性；59.0±13.5 岁；估算肾小球滤过率为 21.3±7.9 mL/min/1.73 m²）。肠道习惯通过布里斯托粪便量表（BSS<3，粪便质地硬且排便频率低；BSS≥3，代表更规律的排便习惯）和罗马 III 标准进行评估。通过高效液相色谱法测定 PCS 和 IS（血清、游离和总；尿、总）。通过 3 天的食物记录评估饮食摄入。
BSS 和罗马 III 标准评估的便秘频率分别为 33%（n=14/43）和 35%（n=15/43）。BSS<3 与 PCS 升高独立相关，与肾功能和饮食蛋白质-纤维比值无关（β[95%置信区间{CI}]: 血清，总 PCS=1.54[1.06-2.23]，P=0.02；血清游离 PCS=1.40[1.00-1.97]，P=0.05；尿 PCS=1.78[1.10-2.90]，P<.02）。根据罗马 III 标准，便秘患者的血清总 PCS 呈升高趋势（β[95% CI]：1.39[0.95-2.03 μmol/L]，P=0.09），且尿 PCS 显著升高（β[95% CI]：1.80[1.11-2.94 μmol/24 h]，P=0.02）。肠道习惯受损（罗马 III 标准或 BSS）对 IS 没有影响。
便秘可能导致非糖尿病 NDD-CKD 患者 PCS 的产生。
