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Abstract: SA-PO1011

Relationship Between Phosphate Binder Type and Gut Microbiome-Derived Uremic Toxin Levels in Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Wang, Lin-Chun, Renal Research Institute, New York, New York, United States
  • Tapia, Mirell, Renal Research Institute, New York, New York, United States
  • Tao, Xia, Renal Research Institute, New York, New York, United States
  • Chao, Joshua Emmanuel, Renal Research Institute, New York, New York, United States
  • Thwin, Ohnmar, Renal Research Institute, New York, New York, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Thijssen, Stephan, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Grobe, Nadja, Renal Research Institute, New York, New York, United States
Background

Phosphate binder choice may differentially affect gastrointestinal physiology (e.g. colonic transit time and gut microbiota composition). Interestingly, patients on sucroferric oxyhydroxide (SFO; Velphoro®) have lower rates of constipation than those taking sevelamer carbonate (SEV; Renvela®). We hypothesized that phosphate binder choice may affect serum levels of gut microbiome-derived uremic toxins (UTOX). We examined the relationship between the type of prescribed phosphate binder and gut microbiome-derived UTOX levels in hemodialysis (HD) patients treated with either SFO or SEV.

Methods

Weekly blood samples and bowel movement diaries were collected from 16 HD patients during six consecutive weeks per subject. Stool types were categorized according to the Bristol Stool Chart. Nine substances including eight UTOX (7 gut microbiome-derived; 1 mammalian-derived) and tryptophan (TRP) were quantified in serum using liquid chromatography–mass spectrometry. For each substance, we calculated the median concentration per subject, then the median across all subjects. We also report the differences in median serum concentrations between the treatment groups and their respective 95% confidence intervals.

Results

Subject characteristics are shown in Table 1. The SEV group reported a 3.3-fold higher frequency of stool types 1 and 2 (constipation), while stool types 5 to 7 (diarrhea and urgency), indicating reduced colonic transit time, were 1.5-fold more frequent in the SFO group. Most gut microbiome-derived UTOX, including three protein-bound UTOX, showed a trend towards lower serum levels in the SFO group, while one mammalian-derived UTOX and TRP were higher in the SFO group (Table 2).

Conclusion

Compared to SEV, SFO may lower the serum levels of gut microbiome-derived uremic toxins, putatively by decreasing colonic transit time.

Funding

  • Commercial Support –