Prebiotic Therapy with Inulin Associated with Low Protein Diet in Chronic Kidney Disease Patients: Evaluation of Nutritional, Cardiovascular and Psychocognitive Parameters.
Study Goal
The researchers aimed to determine how a low-protein diet (LPD), with or without inulin supplementation, modulates inflammatory, metabolic, and psychocognitive markers in CKD patients.
Results Summary
The study found that LPD with inulin improved glycemic and lipid metabolism, reduced systemic inflammation, and enhanced quality of life and mood in CKD patients, though cognitive function did not significantly improve. Both groups showed reductions in serum nitrogen, phosphorus, and uric acid, as well as improved metabolic acidosis.
Population
CKD patients on conservative therapy (n=41, 18 in intervention group, 23 in control group).
Effective Dosage
LPD (0.6 g/kg/day) plus inulin (19 g/day) for the intervention group; LPD alone for controls.
Duration
Six months.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
low-protein diet (LPD) plus inulin | decrease | serum nitrogen | CKD patients | p ≤ 0.01 | significant reduction | #1 |
low-protein diet (LPD) plus inulin | decrease | serum phosphorus | CKD patients | p ≤ 0.01 | significant reduction | #2 |
low-protein diet (LPD) plus inulin | decrease | serum uric acid | CKD patients | p ≤ 0.03 | significant reduction | #3 |
low-protein diet (LPD) plus inulin | increase | metabolic acidosis | CKD patients | p ≤ 0.01 | improvement | #4 |
low-protein diet (LPD) plus inulin | decrease | serum insulin | CKD patients | p = 0.008 | reduction | #5 |
low-protein diet (LPD) plus inulin | decrease | fasting glucose levels | CKD patients | p = 0.022 | reduction | #6 |
low-protein diet (LPD) plus inulin | decrease | HOMA-IR | CKD patients | p = 0.004 | reduction | #7 |
low-protein diet (LPD) plus inulin | decrease | total serum cholesterol | CKD patients | p = 0.012 | lower | #8 |
low-protein diet (LPD) plus inulin | decrease | triglycerides | CKD patients | p = 0.016 | lower | #9 |
low-protein diet (LPD) plus inulin | decrease | C-reactive protein | CKD patients | p = 0.044 | lower | #10 |
low-protein diet (LPD) plus inulin | decrease | homocysteine | CKD patients | p = 0.044 | lower | #11 |
low-protein diet (LPD) plus inulin | increase | HDL | CKD patients | p < 0.001 | higher | #12 |
low-protein diet (LPD) plus inulin | increase | some quality of life and functional status indices (SF-36 survey) | CKD patients | - | significant amelioration | #13 |
low-protein diet (LPD) plus inulin | no change | cognitive state (MMSE) | CKD patients | - | without a significant improvement | #14 |
low-protein diet (LPD) plus inulin | increase | mood (by HAM-D and BDI-II) | CKD patients | - | amelioration | #15 |
low-protein diet (LPD) without inulin | decrease | serum nitrogen | CKD patients | p ≤ 0.01 | significant reduction | #16 |
low-protein diet (LPD) without inulin | decrease | serum phosphorus | CKD patients | p ≤ 0.01 | significant reduction | #17 |
low-protein diet (LPD) without inulin | decrease | serum uric acid | CKD patients | p ≤ 0.03 | significant reduction | #18 |
low-protein diet (LPD) without inulin | increase | metabolic acidosis | CKD patients | p ≤ 0.01 | improvement | #19 |
low-protein diet (LPD) without inulin | increase | mood (only by BID-II) | CKD patients | - | amelioration | #20 |
A relationship between dysbiotic gut microbiome and chronic kidney disease (CKD) has been recently documented; it contributes to CKD-related complications, including cardiovascular disease. Aim: We tested how a low-protein diet (LPD)-with or without oral inulin supplementation as a prebiotic-modulates some inflammatory, atherosclerosis and endothelial dysfunction indices and nutritional markers, as well as psychocognitive functions in CKD patients. We conducted a prospective, case-control study on CKD patients on conservative therapy, divided in two groups: the intervention group treated with LPD (0.6 g/kg/day) plus inulin (19 g/day) and a control group treated with LPD without inulin, for six consecutive months. Clinical and hematochemical parameters as well as instrumental, and psychocognitive assessments (by SF-36 survey and MMSE, HAM-D, BDI-II) were recorded in all the participants at baseline (T0), at three months (T1) and at six months (T2). A total of 41 patients were enrolled: 18 in the intervention group and 23 in the control group. At T2, in both groups, we observed a significant reduction of serum nitrogen and phosphorus (p ≤ 0.01) and serum uric acid (p ≤ 0.03), and an improvement in metabolic acidosis (bicarbonates, p ≤ 0.01; base excess, p ≤ 0.02). Moreover, at T2 the intervention group showed a reduction in serum insulin (p = 0.008) and fasting glucose levels (p = 0.022), HOMA-IR (p = 0.004), as well as lower total serum cholesterol (p = 0.012), triglycerides (p = 0.016), C-reactive protein (p = 0.044) and homocysteine (p = 0.044) and higher HDL (p < 0.001) with respect to baseline. We also observed a significant amelioration of some quality of life and functional status indices (SF-36 survey) among the intervention group compared to controls, without a significant improvement in the cognitive state (MMSE). On the other hand, an amelioration in mood (by HAM-D and BDI-II) was found in the intervention group and in controls (only by BID-II). In conclusion, LPD in association with oral inulin supplementation improved glycemic and lipid metabolism and ameliorated the systemic inflammatory state, likely reducing cardiovascular risk in CKD patients and this may represent a promising therapeutic option, also improving quality of life and mood.