Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objectives: Systemic inflammation has been reported to be associated with uremic pruritus (UP). Although a vegetarian diet can reduce systemic inflammation in hemodialysis patients, the effect of vegetarian diet on UP is not clear. The purpose of the study was to know the possible effects of vegetarian diet on UP.

Methods: A cross-sectional study was done to compare the severity of UP and blood levels of systemic inflammatory markers between vegetarian and non-vegetarian hemodialysis patients. Six non-vegetarian patients with uremic pruritus changed their non-vegetarian diet to vegetarian diet for 2 months. Visual Analogue Scale (VAS) and pruritus score (PS) were used to measure the UP severity. The serum high-sensitivity C-reactive protein (hs-CRP), and interleukin-2 (IL-2) were used as markers of inflammation.

Results: Both the median VAS scores ( p = .043) and the median PS scores ( p < .001) were lower in the Vegetarian than in the non-vegetarian group. The median values of hs-CRP in Vegetarian were lower than that for the non-vegetarian ( p = .020). The median value of IL-2 was also lower in Vegetarian than that of the non-vegetarian ( p = .016). There were 6 non-vegetarian patients shift to vegetarian for 2 months. The pruritus score improved and IL-2 level decreased after change to vegetarian diet.

Conclusion: We concluded that vegetarian diet might be associated with the amelioration of the uremic pruritus severity in hemodialysis patients.

Related collections

Most cited references 22

Record: found
Abstract: found
Article: not found

The production of p-cresol sulfate and indoxyl sulfate in vegetarians versus omnivores.

Kajal P. Patel, Frank Luo, Natalie Plummer … (2012)

The uremic solutes p-cresol sulfate (PCS) and indoxyl sulfate (IS) are generated by colon bacteria acting on food components that escape absorption in the small bowel. The production of these potentially toxic compounds may thus be influenced by diet. This study examined whether production of PCS and IS is different in vegetarians and omnivores. The production of PCS and IS was assessed by measuring their urinary excretion rates in participants with normal kidney function. Studies were carried out in 15 vegetarians and 11 individuals consuming an unrestricted diet. Participants recorded food intake over 4 days and collected urine over the final 2 days of each of two study periods, which were 1 month apart. Average PCS excretion was 62% lower (95% confidence interval [95% CI], 15-83) and average IS excretion was 58% lower (95% CI, 39-71) in vegetarians than in participants consuming an unrestricted diet. Food records revealed that lower excretion of PCS and IS in vegetarians was associated with a 69% higher (95% CI, 20-139) fiber intake and a 25% lower (95% CI, 3-42) protein intake. PCS and IS excretion rates varied widely among individual participants and were not closely correlated with each other but tended to remain stable in individual participants over 1 month. PCS and IS production rates are markedly lower in vegetarians than in individuals consuming an unrestricted diet.

0 comments Cited 84 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The microinflammatory state in uremia: causes and potential consequences.

G Kaysen (2001)

Mortality is markedly elevated in patients with end-stage renal disease. The leading cause of death is cardiovascular disease. Lipoprotein levels are only slightly elevated in dialysis patients, and cardiovascular risk is inversely correlated with serum cholesterol, suggesting that a process other than hyperlipidemia plays a role in the incidence of cardiovascular disease. Hypoalbuminemia, ascribed to malnutrition, has been one of the most powerful risk factors that predict all-cause and cardiovascular mortality in dialysis patients. The presence of inflammation, as evidenced by increased levels of specific cytokines (interleukin-6 and tumor necrosis factor alpha) or acute-phase proteins (C-reactive protein and serum amyloid A), however, has been found to be associated with vascular disease in the general population as well as in dialysis patients. The process of inflammation, also called the acute-phase response, additionally causes loss of muscle mass and changes in plasma composition-decreases in serum albumin, prealbumin, and transferrin levels, also associated with malnutrition. Inflammation alters lipoprotein structure and function as well as endothelial structure and function to favor atherogenesis and increases the concentration of atherogenic proteins in serum, such as fibrinogen and lipoprotein (a). Inflammation in dialysis patients is episodic. The causes are likely to be multifactorial and include vascular access infection, less-than-sterile dialysate, dialysate back leak, and nonbiocompatible membranes in addition to clinically apparent infection. In addition, proinflammatory compounds, such as advanced glycation end products, accumulate in renal failure, and defense mechanisms against oxidative injury are reduced, contributing to inflammation and to its effect on the vascular endothelium.

0 comments Cited 77 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients.

Christiane Pauli-Magnus, Niko Braun, R Dunst … (2006)

Uraemic pruritus (UP) is still one of the most vexing and disabling symptoms in chronic renal failure. The pathogenesis of UP is obscure and effective therapeutic strategies are elusive. Deduced from partial successful treatment modalities, there is evidence that an alteration of the immune system with a pro-inflammatory pattern along with a deranged T-helper-cell differentiation may be involved in the pathogenesis of UP. We, therefore, investigated whether UP is related to an augmented Th1-differentiation as measured by determination of intracytoplasmatic (i.c.) cytokines and expression of chemokine receptors. Additionally, pro-inflammatory cytokines were determined in serum. In a multicentre study, 171 patients on haemodialysis (HD) were screened for UP. Finally, 13 HD patients with and 13 HD patients without UP, as well as 15 healthy controls were enrolled in the study. Peripheral blood mononuclear cells were isolated and the proportion of Th1- and Th2-cells was determined by flow cytometry. The expression of chemokine receptors on CD4 cells (CXCR3 preferentially on Th1 and CCR4 on Th2) and i.c. cytokines (IFNgamma for Th1 and IL4 for Th2) were measured after in vitro stimulation. Serum cytokine levels (IL6 and TNFalpha) and CRP were measured by ELISA. Compared to HD patients without UP, those complaining of UP showed a significantly enhanced proportion of Th1-cells as measured by both techniques. Additionally, serum CRP and IL6 levels were significantly higher in HD patients with UP, compared to HD patients without UP. These results point to a central role of inflammation in the pathogenesis of UP in HD patients.

0 comments Cited 63 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Ren Fail

Journal ID (iso-abbrev): Ren Fail

Journal ID (publisher-id): IRNF

Journal ID (publisher-id): irnf20

Title: Renal Failure

Publisher: Taylor & Francis

ISSN (Print): 0886-022X

ISSN (Electronic): 1525-6049

Publication date Collection: 2018

Publication date (Electronic): 6 November 2018

Volume: 40

Issue: 1

Pages: 514-519

Affiliations

[a ]Kidney Institute and Division of Nephrology, China Medical University Hospital , Taichung, Taiwan;

[b ]Department of Health Care Management, Chang Gung University , Taoyuan, Taiwan;

[c ]Division of Nephrology, Asia University Hospital , Taichung, Taiwan;

[d ]Division of Nephrology, Asia University Hospital , Taichung, Taiwan;

[e ]Division of Nephrology, Asia University Hospital , Taichung, Taiwan;

[f ]Kidney Institute and Division of Nephrology, China Medical University Hospital , Taichung, Taiwan;

[g ]Division of Nephrology, Asia University Hospital , Taichung, Taiwan

Author notes

CONTACT Hung-Chih Chen D51052@ 123456auh.org.tw Division of Nephrology, Asia University Hospital , No. 222, Fuxin Road, Wufeng District, Taichung 41354, Taiwan

[*]

Chun-Yang Tseng and Tai-Te Wu contributed equally to the study.

Article

Publisher ID: 1512871

DOI: 10.1080/0886022X.2018.1512871

PMC ID: 7012008

PubMed ID: 30396306

SO-VID: 12463284-fefe-4615-8c55-ff0b8c7eebb0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 22 June 2018

Date accepted : 12 August 2018

Page count

Pages: 6, Words: 4240

Comments

Comment on this article

scite_

Cited by 10

See all cited by

Most referenced authors 233

See all reference authors

Vegetarian diet may ameliorate uremic pruritus in hemodialysis patients

Read this article at

Abstract

Related collections

Karger: Nephrology

Most cited references 22

The production of p-cresol sulfate and indoxyl sulfate in vegetarians versus omnivores.

The microinflammatory state in uremia: causes and potential consequences.

The role of micro-inflammation in the pathogenesis of uraemic pruritus in haemodialysis patients.

Author and article information

Journal

Affiliations

Author notes

Article

History

Page count

Categories

Comments

Comment on this article

Similar content 808

Cited by 10

Most referenced authors 233