End Stage Kidney Disease

It has is now well known that patients on dialysis and those who have advanced end-stage kidney disease have certain toxins that are produced in the colon by bad intestinal bacteria. Two of these are called indoxyl and cresyl. These toxins then move into the blood and are felt to be significant factors in worsening the kidney disease, coronary symptoms, and even diabetes. The following article provides current thinking on how these toxins play their role and how therapeutic interventions might help.

The colon: an overlooked site for therapeutics in dialysis patients

Additional studies have shown that elevated levels of cresyl in the blood are predictive of cardiovascular and even mortality from all causes. While this does not prove that lowering the cresyl level in the blood would be helpful, it is certainly suggestive of that result.

Serum free p-cresyl sulfate levels predict cardiovascular and all-cause mortality in elderly hemodialysis patients–a prospective cohort study

Of course, the next step in this story would be to see if cresyl blood levels could be reduced by a prebiotic such as oligofructose-enriched inulin which is known to favorably change the makeup of colon bacteria. This study was done in the following paper. What still needs to be shown is whether making these changes over a period of time makes any difference in patients symptoms and life course.

P-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin