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Effect of sucroferric oxyhydroxide on gastrointestinal microbiome and uremic toxins in patients with chronic kidney disease undergoing hemodialysis

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Abstract

Background

In patients with chronic kidney disease (CKD), dysbiosis in the gastrointestinal microbiome is thought to be associated with increased production of uremic toxins, such as indoxyl sulfate (IS) and p-cresyl sulfate (PCS). Sucroferric oxyhydroxide (SFO), an iron-based phosphate binder, may affect the gastrointestinal microbiome and the production of uremic toxins. We aimed to examine whether SFO administration affected distribution of gastrointestinal microbiome and serum uremic toxin levels in CKD patients undergoing hemodialysis.

Methods

In this single-center, open-label, interventional study, 18 maintenance hemodialysis patients with hyperphosphatemia were prescribed with SFO. We collected serum samples before and after 3 months of administration, and serum levels of IS and PCS were measured. A control group of 20 hemodialysis patients without SFO was evaluated. We evaluated gastrointestinal microbiome of patients pre- and post-SFO administration by 16S rDNA sequencing and bioinformatics analysis.

Results

Serum IS and PCS levels were significantly elevated after administration of SFO (IS before 2.52 ± 1.60 mg/dl vs. after 3.13 ± 1.51 mg/dl, P = 0.008; PCS before 2.32 ± 2.44 mg/dl vs. after 3.45 ± 2.11 mg/dl, P = 0.002), while serum IS and PCS levels did not change in the control group. Microbiome analysis in the SFO group showed no significant change in diversity and major components in phylum, class, order, family, gene, and species.

Conclusion

Administration of SFO increased the serum levels of IS and PCS with no change of major components of gastrointestinal microbiome.

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Funding

This study was supported by a grant from The Kidney Foundation, Japan.

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Authors and Affiliations

  1. Department of Internal Medicine, Nagaoka Red-Cross Hospital, 2-297-1 Sensyu, Nagaoka, Niigata, 940-2085, Japan

    Akira Iguchi, Takako Saeki & Hajime Yamazaki

  2. Division of Blood Purification Therapy, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Suguru Yamamoto

  3. Department of Nephrology and Hypertension, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan

    Akira Oda, Kenichi Tanaka & Junichiro James Kazama

  4. Department of Microbiology, Fukushima Medical University, 1 Hikariga-oka, Fukushima, Fukushima, 960-1295, Japan

    Ken Ishioka & Tatsuo Suzutani

  5. Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Ichiei Narita

Authors
  1. Akira Iguchi
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  2. Suguru Yamamoto
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  3. Akira Oda
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  7. Hajime Yamazaki
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  9. Tatsuo Suzutani
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Corresponding author

Correspondence to Akira Iguchi.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study protocol was performed in accordance with the ethical guidelines of the　Declaration of Helsinki and was approved by the human research committee at our institution (authorization No. 1849). Written informed consent was obtained from all participants. The study is registered with the UMIN Clinical Trials Registry (No. 000026667). This study was a prospective, open-label interventional study.

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Iguchi, A., Yamamoto, S., Oda, A. et al. Effect of sucroferric oxyhydroxide on gastrointestinal microbiome and uremic toxins in patients with chronic kidney disease undergoing hemodialysis. Clin Exp Nephrol 24, 725–733 (2020). https://doi.org/10.1007/s10157-020-01892-x

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  • DOI: https://doi.org/10.1007/s10157-020-01892-x

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