Journal
ADVANCES IN NUTRITION
Volume 10, Issue 2, Pages 303-320Publisher
ELSEVIER SCIENCE INC
DOI: 10.1093/advances/nmy068
Keywords
resistant starch; high-amylose maize starch; chronic kidney disease; diabetic nephropathy; microbiota; microbiome; short-chain fatty acids; uremic retention solutes
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Funding
- Australian Postgraduate Award from the JDRF Australian Type 1 Diabetes Clinical Research Network, a special initiative of the Australian Research Council
- JDRF Australian Type 1 Diabetes Clinical Research Network, a special initiative of the Australian Research Council
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Chronic kidney disease (CKD) has been associated with changes in gut microbial ecology, or dysbiosis, which may contribute to disease progression. Recent studies have focused on dietary approaches to favorably alter the composition of the gut microbial communities as a treatment method in CKD. Resistant starch (RS), a prebiotic that promotes proliferation of gut bacteria such as Bifidobacteria and Lactobacilli, increases the production of metabolites including short-chain fatty acids, which confer a number of health-promoting benefits. However, there is a lack of mechanistic insight into how these metabolites can positively influence renal health. Emerging evidence shows that microbiota-derived metabolites can regulate the incretin axis and mitigate inflammation via expansion of regulatory T cells. Studies from animal models and patients with CKD show that RS supplementation attenuates the concentrations of uremic retention solutes, including indoxyl sulfate and p-cresyl sulfate. Here, we present the current state of knowledge linking the microbiome to CKD, we explore the efficacy of RS in animal models of CKD and in humans with the condition, and we discuss how RS supplementation could be a promising dietary approach for slowing CKD progression.
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