Our gut microbiota process food nutrients in such a way that can generate uremic toxins or precursors metabolized to toxins in patients with chronic kidney disease (CKD). Some key uremic toxins include Trimethylamine N-Oxide (TMAO), p-cresyl-sulfate (pCS), indoxyl-sulfate (IS) and indole-3 acetic acid (IAA), all of which are important in the homeostasis and disposal of oxalate. TMAO is an amine oxide derived from dietary seafood, and has been associated with an increased risk of cardiac disease. New research shows uremic toxins may also be generated from dietary choline and D,L-carnitine. For healthy people, TMAO is excreted by the kidneys, but in individuals with CKD, it can accumulate as uremic toxins.
The authors of this study suggest that physicians explore the dietary habits of their CKD patients, and monitor their supplementation accordingly, to ensure there is no additional production of uremic toxins by their gut microbes. They recommend a close evaluation in dietary habits, and, also, the use of prebiotics and/or probiotics.