Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Pediatr Nephrol. 2021 Jun;36(6):1589-1595. doi: 10.1007/s00467-020-04840-9. Epub 2021 Jan 2.
Chronic kidney disease (CKD) in children is a pro-inflammatory condition leading to a high morbidity and mortality. Accumulation of organic metabolic waste products, coined as uraemic toxins, parallels kidney function decline. Several of these uraemic toxins are protein-bound (PBUT) and gut-derived. Gut dysbiosis is a hallmark of CKD, resulting in a state of increased proteolytic fermentation that might be counteracted by dietary fibre. Data on fibre intake in children with CKD are lacking. We aimed to assess dietary fibre intake in a paediatric CKD cohort and define its relationship with PBUT concentrations.
In this multi-centre, cross-sectional observational study, 61 non-dialysis CKD patients (9 ± 5 years) were included. Dietary fibre intake was assessed through the use of 24-h recalls or 3-day food records and coupled to total and free levels of 4 PBUTs (indoxyl sulfate (IxS), p-cresyl sulfate (pCS), p-cresyl glucuronide (pCG) and indole acetic acid (IAA).
In general, fibre intake was low, especially in advanced CKD: 10 ± 6 g/day/BSA in CKD 4-5 versus 14 ± 7 in CKD 1-3 (p = 0.017). Lower concentrations of both total (p = 0.036) and free (p = 0.036) pCG were observed in the group with highest fibre intake, independent of kidney function.
Fibre intake in paediatric CKD is low and is even worse in advanced CKD stages. Current dietary fibre recommendations for healthy children are not being achieved. Dietary management of CKD is complex in which too restrictive diets carry the risk of nutritional deficiencies. The relation of fibre intake with PBUTs remains unclear and needs further investigation. Graphical abstract.
儿童慢性肾脏病（CKD）是一种炎症状态，导致高发病率和死亡率。有机代谢废物的积累，被称为尿毒症毒素，与肾功能下降平行。这些尿毒症毒素中有几种是蛋白结合的（PBUT）和肠道来源的。肠道菌群失调是 CKD 的一个标志，导致蛋白水解发酵增加，而膳食纤维可能对此有拮抗作用。关于 CKD 儿童膳食纤维摄入量的数据尚缺乏。我们旨在评估小儿 CKD 队列的膳食纤维摄入量，并确定其与 PBUT 浓度的关系。
在这项多中心、横断面观察性研究中，纳入了 61 名非透析 CKD 患儿（9±5 岁）。通过 24 小时回忆或 3 天食物记录来评估膳食纤维摄入量，并与 4 种 PBUT（吲哚硫酸酯（IxS）、对甲酚硫酸盐（pCS）、对甲酚葡萄糖醛酸（pCG）和吲哚乙酸（IAA）的总浓度和游离浓度相关联。
总的来说，膳食纤维的摄入量较低，尤其是在 CKD 晚期：CKD 4-5 期为 10±6 g/BSA/天，而 CKD 1-3 期为 14±7 g/BSA/天（p=0.017）。在膳食纤维摄入量最高的组中，观察到总浓度（p=0.036）和游离浓度（p=0.036）的 pCG 均较低，与肾功能无关。
小儿 CKD 的膳食纤维摄入量较低，在晚期 CKD 阶段更差。目前针对健康儿童的膳食纤维推荐量并未达到。CKD 的饮食管理较为复杂，过于严格的饮食可能会导致营养缺乏。膳食纤维摄入量与 PBUT 之间的关系尚不清楚，需要进一步研究。
