Effect of fructooligosaccharide on endothelial function in CKD patients: a randomized controlled trial

Area of Science:

• Nephrology
• Gastroenterology
• Cardiovascular Medicine

Background:

• Microbiota-derived uremic toxins contribute to inflammation, endothelial dysfunction, and cardiovascular risk in chronic kidney disease (CKD).
• Prebiotics may modulate the gut microbiota and mitigate these effects.

Purpose of the Study:

• To investigate the impact of fructooligosaccharide (FOS) on endothelial function and arterial stiffness in non-dialysis CKD patients.
• To assess changes in inflammatory markers and uremic toxins.

Main Methods:

• A 3-month, double-blind, placebo-controlled trial involving 46 non-diabetic CKD patients.
• Participants received 12g/day of FOS or maltodextrin placebo.
• Measurements included uremic toxins (PCS, IS, TMAO), inflammatory markers (CRP, IL-6), nitric oxide, SDF-1α, flow-mediated dilatation (FMD), and pulse wave velocity (PWV).

Main Results:

• FOS supplementation significantly decreased IL-6 levels (P=0.04) and showed a trend toward reducing p-cresyl sulfate (PCS) (P=0.07).
• No significant differences in FMD or PWV were observed between groups overall.
• Exploratory analysis indicated FMD remained stable in the FOS group while decreasing in the placebo group for patients with less severe endothelial dysfunction (FMD ≥ 2.2%).

Conclusions:

• Fructooligosaccharide (FOS) effectively lowered IL-6 levels in CKD patients.
• FOS demonstrated a potential to preserve endothelial function in CKD patients with less compromised endothelium.
• FOS did not show a significant effect on arterial stiffness in this cohort.