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Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain

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Abstract

Background

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.

Methods

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).

Results

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.

Conclusions

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.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors wish to thank Sofie Vermeiren, Els Holvoet, Sophie Lobbestael, Tom Mertens, Maria Van Landschoot, An Desloovere, Sofie Eerens, Kimi Lambregts, Katrien Wellens, Jarrik Fransen, Imelda Hamels, Ariadne van Hulle, Katrien Van der Vaerent and Julia Versavau for their assistance.

Funding

This study was funded by the Agency for Innovation by Science and Technology (IWT), from the ‘Applied Biomedical Research with a Primary Societal Goal’ (TBM) program in Flanders (Belgium): UToPaed project, grant number IWT-TBM 150195. J.V.W. received lecture fees from Vitaflo and is member of the European Society for Paediatric Nephrology nutritional task force (with Vitaflo grant).

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Author notes

  1. Ann Raes and Sunny Eloot contributed equally to this work.

Authors and Affiliations

  1. Paediatric Nephrology and Rheumatology Section, Department of Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Amina El Amouri, Evelien Snauwaert, Johan Vande Walle & Ann Raes

  2. Nephrology Section, Department of Internal Medicine and Paediatrics, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Aurélie Foulon, Charlotte Vande Moortel, Griet Glorieux, Wim Van Biesen & Sunny Eloot

  3. Paediatric Nephrology Section, Department of Paediatrics, University Hospitals Leuven (campus Gasthuisberg), Herestraat 49, 3000, Leuven, Belgium

    Maria Van Dyck

  4. Paediatric Nephrology Section, Department of Paediatrics, Antwerp University Hospital, 2650 Edegem, Antwerp, Wilrijkstraat 10, Belgium

    Koen Van Hoeck

  5. Paediatric Nephrology Section, Department of Paediatrics, Cliniques Universitaires St. Luc, Université Catholique Louvain, Avenue Hippocrate 10, 1200, Brussels, Belgium

    Nathalie Godefroid

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  1. Amina El Amouri
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Contributions

Conceptualisation: Amina El Amouri, Evelien Snauwaert, Sunny Eloot, Ann Raes, Wim Van Biesen; methodology: Amina El Amouri, Evelien Snauwaert, Griet Glorieux, Sunny Eloot, Ann Raes; formal analysis and investigation: Amina El Amouri, Aurélie Foulon, Charlotte Vande Moortel, Evelien Snauwaert, Maria Van Dyck, Koen Van Hoeck, Nathalie Godefroid, Sunny Eloot; writing—original draft preparation: Amina El Amouri; writing—review and editing: Amina El Amouri, Evelien Snauwaert, Sunny Eloot, Ann Raes, Johan Vande Walle, Griet Glorieux, Wim Van Biesen; funding acquisition: Sunny Eloot, Ann Raes; resources: Wim Van Biesen, Griet Glorieux; supervision: Evelien Snauwaert, Sunny Eloot, Ann Raes.

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Correspondence to Amina El Amouri.

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El Amouri, A., Snauwaert, E., Foulon, A. et al. Dietary fibre intake is low in paediatric chronic kidney disease patients but its impact on levels of gut-derived uraemic toxins remains uncertain. Pediatr Nephrol 36, 1589–1595 (2021). https://doi.org/10.1007/s00467-020-04840-9

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  • DOI: https://doi.org/10.1007/s00467-020-04840-9

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