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Abstract: FR-OR127

Resistant Starch Supplementation Reduces Indoxyl Sulfate Levels in Hemodialysis Patients: A Randomized, Double-Blind, Crossover, Placebo-Controlled Study

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1302 Health Maintenance, Nutrition, and Metabolism: Clinical


  • Mafra, Denise, Federal University Fluminense, Rio de Janeiro, RIO DE JANEIRO, Brazil
  • Esgalhado, Marta, Federal University Fluminense, Rio de Janeiro, RIO DE JANEIRO, Brazil
  • Macedo, Renata De azevedo, Federal Fluminense University, Rio de Janeiro, RJ, Brazil
  • Kemp, Julie ann, Federal University Fluminense, Rio de Janeiro, RIO DE JANEIRO, Brazil
  • Paiva, Bruna, Federal University Fluminense, Rio de Janeiro, RIO DE JANEIRO, Brazil
  • Nakao, Lia S., UFPR, Curitiba, Brazil
  • Cunha, Diana Barbosa, State University of Rio de Janeiro, Rio de Janeiro, Brazil
  • Borges, Natalia Alvarenga, Universidade Federal Fluminense, Rio de Janeiro, Brazil

Protein-bound uremic toxins produced from intestinal bacterial protein fermentation, including indoxyl sulfate (IS) and p-cresyl sulfate (p-CS), tend to accumulate in chronic kidney disease (CKD) patients. These patients have a gut microbiota imbalance that leads to loss of gut barrier integrity, facilitating the passage of IS and p-CS into the bloodstream. Both solutes are linked with the progression of renal disease, as well as, cardiovascular disease (CVD). Strategies like prebiotic supplementation may be effective to restore the balance of the gut microbiota. This study tested whether prebiotic resistant starch (RS) supplementation would reduce IS and p-CS plasma levels in hemodialysis patients (HD).


Thirty eight stable HD patients were randomized in RS (n=19) or Placebo (n=19) groups to receive alternately 9 cookies/day (dialysis days) and 1 sachet/day (non-dialysis days) containing 16 g of RS (Hi-Maize 260, Ingredion®) or manioc flour for 4 weeks and then after the washout period (4 weeks) were crossed over to the alternative for an additional 4 weeks. Fasting pre-dialysis plasma IS and p-CS were analyzed by reversed-phase high-performance liquid chromatography. Food intake was also recorded. Intention-to-treat analysis were performed in order to verify the variation of IS and p-CS plasma levels according to allocation groups, by means of mixed linear models is SAS.


Twenty six patients concluded the study, 12 in RS-Placebo group (42% male, 54.8±7.9 years, 53.0±40.5 months of HD, 26.7±5.1 Kg/m2) and 14 in Placebo-RS group (71% male, 54.2±11.9 years, 44.1±23.0 months of HD, 26.2±4.8 Kg/m2). After 4 weeks, IS plasma levels were significantly reduced in the RS group [-6.2 (-9.7/-3.3)mg/L] compared to placebo [2.2 (-5.9/4.5)mg/L] (p=0.006). No significant alterations was observed in plasma p-CS levels or food intake (besides fiber intake has increased with RS).


Prebiotic RS supplementation seems to be an effective nutritional strategy to reduce plasma IS levels in CKD patients on HD. These findings support the hypothesis that prebiotics may be a new non-pharmacological intervention to modulate gut microbiota.


  • Government Support - Non-U.S.