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Inulin-type prebiotics reduce serum uric acid levels via gut microbiota modulation: a randomized, controlled crossover trial in peritoneal dialysis patients

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European Journal of Nutrition Aims and scope Submit manuscript

Abstract

Purpose

Increased levels of uric acid (UA), which is mainly excreted through the kidneys, are independently associated with higher mortality in end-stage renal disease (ESRD) patients. The uricolysis of gut microbiota plays an important role in extrarenal excretion of UA. This study aimed to examine the effect of inulin-type prebiotics (a type of fermentable dietary fiber) on intestinal microbiota modulation and serum UA levels in ESRD patients.

Methods

Continuous ambulatory peritoneal dialysis (CAPD) patients were recruited to a randomized, double-blind, placebo-controlled crossover trial of 12-week inulin-type prebiotics. Participants were visited before and after treatment with prebiotics or placebo. Serum UA levels, dietary purine intake, serum xanthine oxidase (XO) activity, daily “renal excretion” of UA, and fecal UA degradation capability were measured at each visit. Fecal metagenomic analysis was conducted to assess microbial composition and function.

Results

Sixteen participants (mean age = 37 y; 10 men and 6 women) completed the trial, and 64 specimens were analyzed. The average concentration of serum UA decreased by approximately 10% in the prebiotic intervention group in comparison to the placebo group (p = 0.047) without an increase in daily “renal excretion” of UA via urine and dialysate. There were no significant changes in purine intake or activity of XO. Notably, enhanced fecal UA degradation was observed after prebiotic intervention (p = 0.041), and the ratio of Firmicutes/Bacteroidetes, which was positively associated with fecal UA degradation, increased in the prebiotic period (p = 0.032). Furthermore, prebiotics enriched purine-degrading species in the gut microbiota, including unclassified_o_Clostridiales, Clostridium sp. CAG:7, Clostridium sp. FS41, Clostridium citroniae, Anaerostipes caccae, and Clostridium botulinum.

Conclusions

Inulin-type prebiotics is a promising therapeutic candidate to reduce serum UA levels in renal failure patients, and this urate-lowering effect could possibly be attributed to intestinal microbial degradation of UA.

Trial registry

This study was registered at the Chinese Clinical Trials Registry (http://www.chictr.org.cn/), registration ID: ChiCTR-INR-17013739, registration date: 6th Dec 2017.

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Data availability

Sequence data are available for download from the Sequence Read Archive with accession number PRJNA750234.

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Acknowledgements

We thank all the participants in this clinical trial, and thank for the support from faculties and staffs in Department of Clinical Nutrition and Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Funding

This work was supported by National Natural Science Foundation of China [grant numbers: 81673161].

Author information

Authors and Affiliations

  1. Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan, 430030, Hubei, China

    Shuiqing He, Qianqian Xiong, Li Li, Jing Zhao, Xuechun Lin, Xiaolei Guo, Yuqin He & Chenjiang Ying

  2. School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China

    Chong Tian

  3. Department of Nephrology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China

    Wangqun Liang

  4. Department of Clinical Nutrition, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, No. 1095 Jiefang Road, Wuhan, 430030, Hubei, China

    Xuezhi Zuo

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  1. Shuiqing He
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  3. Chong Tian
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Contributions

All authors read the manuscript, interpreted the results, provided critical intellectual content, and approved the final manuscript. YC and ZX designed the project conception and development of the overall research plan. He S completed laboratory detection, analyzed the data and wrote the first draft of the manuscript. LW contributed to volunteer recruitment. XQ and TC revised the manuscript. LL contributed to statistics analysis. Other listed authors contributed to collecting samples and laboratory detection.

Corresponding authors

Correspondence to Xuezhi Zuo or Chenjiang Ying.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval for this study was obtained from the Institutional Review Board of Tongji Hospital, Huazhong University of Science and Technology (TJ-IRB20171110), and registered at the Chinese Clinical Trials Registry (http://www.chictr.org.cn/. Registration ID: ChiCTR-INR-17013739). Informed consent was obtained before the study commenced in accordance with the Declaration of Helsinki.

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He, S., Xiong, Q., Tian, C. et al. Inulin-type prebiotics reduce serum uric acid levels via gut microbiota modulation: a randomized, controlled crossover trial in peritoneal dialysis patients. Eur J Nutr 61, 665–677 (2022). https://doi.org/10.1007/s00394-021-02669-y

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