Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Emerging evidence supports the beneficial effects of dietary fiber supplementation in alleviating gut dysbiosis, which leads to a reduction in uremic toxins and inflammatory markers in chronic kidney disease (CKD) patients. However, current evidence-based renal nutrition guidelines do not provide re...
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2025-01-01
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| author | Wannasit Wathanavasin Wisit Cheungpasitporn Charat Thongprayoon Tibor Fülöp |
| author_facet | Wannasit Wathanavasin Wisit Cheungpasitporn Charat Thongprayoon Tibor Fülöp |
| author_sort | Wannasit Wathanavasin |
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| description | Emerging evidence supports the beneficial effects of dietary fiber supplementation in alleviating gut dysbiosis, which leads to a reduction in uremic toxins and inflammatory markers in chronic kidney disease (CKD) patients. However, current evidence-based renal nutrition guidelines do not provide recommendations regarding dietary fiber intake. We performed a systematic review and meta-analysis to investigate and highlight the effects of dietary fiber supplementation on modulating uremic toxins and inflammatory markers in individuals with CKD, with or without dialysis. The eligible randomized controlled trials (RCTs) were identified from PubMed, Scopus, and Cochrane Central Register of Controlled trials until 27 November 2024. The results were synthesized using a random-effects model and presented as standardized mean differences (SMDs) with a 95% confidence interval (CI). A total of 21 studies with 700 patients were included. When compared with the control group, dietary fiber supplementation ranging from 6 to 50 g/day, for typically more than 4 weeks, could significantly reduce the levels of serum uremic toxins, including p-cresyl sulfate, indoxyl sulfate, and blood urea nitrogen (SMD −0.22, −0.34, −0.25, respectively, with <i>p</i>-values < 0.05), as well as biomarkers of inflammation, including interleukin-6 and tumor necrosis factor alpha (SMD −0.44, −0.34, respectively, with <i>p</i>-values < 0.05). These beneficial effects were consistent across different types of fibers and CKD status (with or without dialysis). However, no significant reduction in serum trimethylamine N-oxide, uric acid, and high-sensitivity C-reactive protein levels was observed with dietary fiber intervention. This study would pave the way for prioritizing dietary quality, particularly a fiber-rich diet, beyond the traditional focus on the quantities of protein, energy, and electrolyte restrictions among individuals with CKD. |
| format | Article |
| id | doaj-art-d02d64f90cf94b8b8d3a1b558ce844f7 |
| institution | DOAJ |
| issn | 2072-6651 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
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| series | Toxins |
| spelling | doaj-art-d02d64f90cf94b8b8d3a1b558ce844f72025-08-20T02:45:38ZengMDPI AGToxins2072-66512025-01-011725710.3390/toxins17020057Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsWannasit Wathanavasin0Wisit Cheungpasitporn1Charat Thongprayoon2Tibor Fülöp3Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USAMedicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USAEmerging evidence supports the beneficial effects of dietary fiber supplementation in alleviating gut dysbiosis, which leads to a reduction in uremic toxins and inflammatory markers in chronic kidney disease (CKD) patients. However, current evidence-based renal nutrition guidelines do not provide recommendations regarding dietary fiber intake. We performed a systematic review and meta-analysis to investigate and highlight the effects of dietary fiber supplementation on modulating uremic toxins and inflammatory markers in individuals with CKD, with or without dialysis. The eligible randomized controlled trials (RCTs) were identified from PubMed, Scopus, and Cochrane Central Register of Controlled trials until 27 November 2024. The results were synthesized using a random-effects model and presented as standardized mean differences (SMDs) with a 95% confidence interval (CI). A total of 21 studies with 700 patients were included. When compared with the control group, dietary fiber supplementation ranging from 6 to 50 g/day, for typically more than 4 weeks, could significantly reduce the levels of serum uremic toxins, including p-cresyl sulfate, indoxyl sulfate, and blood urea nitrogen (SMD −0.22, −0.34, −0.25, respectively, with <i>p</i>-values < 0.05), as well as biomarkers of inflammation, including interleukin-6 and tumor necrosis factor alpha (SMD −0.44, −0.34, respectively, with <i>p</i>-values < 0.05). These beneficial effects were consistent across different types of fibers and CKD status (with or without dialysis). However, no significant reduction in serum trimethylamine N-oxide, uric acid, and high-sensitivity C-reactive protein levels was observed with dietary fiber intervention. This study would pave the way for prioritizing dietary quality, particularly a fiber-rich diet, beyond the traditional focus on the quantities of protein, energy, and electrolyte restrictions among individuals with CKD.https://www.mdpi.com/2072-6651/17/2/57dietary fiberuremic toxinschronic kidney diseaseinflammationgut dysbiosis |
| spellingShingle | Wannasit Wathanavasin Wisit Cheungpasitporn Charat Thongprayoon Tibor Fülöp Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Toxins dietary fiber uremic toxins chronic kidney disease inflammation gut dysbiosis |
| title | Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full | Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_short | Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_sort | effects of dietary fiber supplementation on modulating uremic toxins and inflammation in chronic kidney disease patients a systematic review and meta analysis of randomized controlled trials |
| topic | dietary fiber uremic toxins chronic kidney disease inflammation gut dysbiosis |
| url | https://www.mdpi.com/2072-6651/17/2/57 |
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