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Investigation of a targeted panel of gut microbiome-derived toxins in children with chronic kidney disease
Journal article   Open access   Peer reviewed

Investigation of a targeted panel of gut microbiome-derived toxins in children with chronic kidney disease

Mina Ebrahimi, Stephen R Hooper, Mark M Mitsnefes, Ramachandran S Vasan, Paul L Kimmel, Bradley A Warady, Susan L Furth, Erum A Hartung, Michelle R Denburg and Arthur M Lee
Pediatric nephrology (Berlin, West), v 40(5), pp 1759-1770
01 May 2025
PMID: 39820505
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC12376272/View
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Abstract

Adolescent Child Child, Preschool Cresols - blood Female Gastrointestinal Microbiome - physiology Glomerular Filtration Rate Glutamine - analogs & derivatives Humans Indican - blood Indoleacetic Acids - blood Infant Kidney - physiopathology Male Prospective Studies Renal Insufficiency, Chronic - blood Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - microbiology Renal Insufficiency, Chronic - physiopathology Sulfuric Acid Esters - blood
The gut-kidney axis is implicated in chronic kidney disease (CKD) morbidity. We describe how a panel of gut microbiome-derived toxins relates to kidney function and neurocognitive outcomes in children with CKD, consisting of indoleacetate, 3-indoxylsulfate, p-cresol glucuronide, p-cresol sulfate, and phenylacetylglutamine. The Chronic Kidney Disease in Children (CKiD) cohort is a North American multicenter prospective cohort that enrolled children aged 6 months to 16 years with estimated glomerular filtration rate (eGFR) 30-89 ml/min/1.73 m . Data from the 2-year study visit were used for this analysis. Toxin quantification (Metabolon Inc., Durham, NC) was performed with ultra-high performance liquid chromatography/tandem mass spectrometry. Executive function and echocardiograms were assessed. Regression analysis examined the association of toxin levels with eGFR, CKD etiology, and neurocognitive and cardiac assessments (adjusted for age, sex, and urine protein:creatinine [UPCR]). There were 150 CKiD participants included in this study. All toxins levels were significantly inversely correlated with eGFR (Spearman's rho - 0.45 to - 0.69). Children with non-glomerular CKD had significantly higher levels of 3-indoxylsulfate, phenylacetylglutamine, and p-cresol glucuronide. The toxin levels did not associate with neurocognitive outcomes. P-cresol glucuronide and phenylacetylglutamine negatively associated with left ventricular mass index z score, but did not associate with left ventricular hypertrophy. Children with CKD have high levels of circulating gut microbiome-derived toxins. The levels of these toxins are strongly correlated with eGFR. There appear to be differences in toxin level based on glomerular versus non-glomerular etiology, even when accounting for the differences in eGFR between these two subgroups. In this sample, we did not detect any associations between these toxin levels and neurocognitive or cardiac outcomes.

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
Urology & Nephrology
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