Rodrigues Fernanda Guedes, Swarte J Casper, Douwes Rianne M, Knobbe Tim J, Sotomayor Camilo G, Blokzijl Hans, Weersma Rinse K, Heilberg Ita P, Bakker Stephan J L, de Borst Martin H
Department of Nephrology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
Nutrition Post Graduation Program, Universidade Federal de São Paulo, São Paulo 04023-062, Brazil.
J Clin Med. 2021 Jun 28;10(13):2854. doi: 10.3390/jcm10132854.
Diarrhea is common among kidney transplant recipients (KTR). Exhaled hydrogen (H) is a surrogate marker of small bowel dysbiosis, which may drive diarrhea. We studied the relationship between exhaled H and diarrhea in KTR, and explored potential clinical and dietary determinants.
Clinical, laboratory, and dietary data were analyzed from 424 KTR participating in the TransplantLines Biobank and Cohort Study (NCT03272841). Fasting exhaled H concentration was measured using a model DP Quintron Gas Chromatograph. Diarrhea was defined as fast transit time (types 6 and 7 according to the Bristol Stool Form Scale, BSFS) of 3 or more episodes per day. We studied the association between exhaled H and diarrhea with multivariable logistic regression analysis, and explored potential determinants using linear regression.
KTR (55.4 ± 13.2 years, 60.8% male, mean eGFR 49.8 ± 19.1 mL/min/1.73 m) had a median exhaled H of 11 (5.0-25.0) ppm. Signs of small intestinal bacterial overgrowth (exhaled H ≥ 20 ppm) were present in 31.6% of the KTR, and 33.0% had diarrhea. Exhaled H was associated with an increased risk of diarrhea (odds ratio 1.51, 95% confidence interval 1.07-2.14 per log ppm, = 0.02). Polysaccharide intake was independently associated with higher H (std. β 0.24, = 0.01), and a trend for an association with proton-pump inhibitor use was observed (std. β 0.16 = 0.05).
Higher exhaled H is associated with an increased risk of diarrhea in KTR. Our findings set the stage for further studies investigating the relationship between dietary factors, small bowel dysbiosis, and diarrhea after kidney transplantation.
腹泻在肾移植受者（KTR）中很常见。呼出氢气（H）是小肠生态失调的替代标志物，可能导致腹泻。我们研究了KTR中呼出H与腹泻之间的关系，并探讨了潜在的临床和饮食决定因素。
分析了参与移植线生物样本库和队列研究（NCT03272841）的424名KTR的临床、实验室和饮食数据。使用DP Quintron气相色谱仪模型测量空腹呼出H浓度。腹泻定义为每天3次或更多次的快速转运时间（根据布里斯托大便形态量表，BSFS为6型和7型）。我们通过多变量逻辑回归分析研究了呼出H与腹泻之间的关联，并使用线性回归探索了潜在的决定因素。
KTR（年龄55.4±13.2岁，男性60.8%，平均eGFR 49.8±19.1 mL/min/1.73 m²）呼出H的中位数为11（5.0-25.0）ppm。31.6%的KTR存在小肠细菌过度生长迹象（呼出H≥20 ppm），33.0%的KTR有腹泻。呼出H与腹泻风险增加相关（优势比1.51，每对数ppm的95%置信区间为1.07-2.14，P=0.02）。多糖摄入量与较高的H独立相关（标准化β0.24，P=0.01），并且观察到与使用质子泵抑制剂有相关趋势（标准化β0.16，P=0.05）。
呼出H升高与KTR腹泻风险增加相关。我们的研究结果为进一步研究饮食因素、小肠生态失调与肾移植后腹泻之间的关系奠定了基础。
