Food-Derived Uremic Toxins in Chronic Kidney Disease

Abstract

Patients with chronic kidney disease (CKD) have a higher cardiovascular risk compared to the average population, and this is partially due to the plasma accumulation of solutes known as uremic toxins. The binding of some solutes to plasma proteins complicates their removal via conventional therapies, e.g., hemodialysis. Protein-bound uremic toxins originate either from endogenous production, diet, microbial metabolism, or the environment. Although the impact of diet on uremic toxicity in CKD is difficult to quantify, nutrient intake plays an important role. Indeed, most uremic toxins are gut-derived compounds. They include Maillard reaction products, hippurates, indoles, phenols, and polyamines, among others. In this review, we summarize the findings concerning foods and dietary components as sources of uremic toxins or their precursors. We then discuss their endogenous metabolism via human enzyme reactions or gut microbial fermentation. Lastly, we present potential dietary strategies found to be efficacious or promising in lowering uremic toxins plasma levels. Aligned with current nutritional guidelines for CKD, a low-protein diet with increased fiber consumption and limited processed foods seems to be an effective treatment against uremic toxins accumulation.

Keywords: chronic kidney disease; diet; food; metabolism; nutrition; uremic toxins.

Figure 1

Overview of foods as sources of protein-bound uremic toxins. The dash lines indicate the metabolization of the precursors of protein-bound uremic toxins by the gut microbiome or by the host. IGPs = intermediate glycation products; AGEs = advanced glycation products; CMPF = 3-Carboxy-4-methyl-5-propyl-2-furanpropionate. Created with BioRender.com.