ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: FR-PO934

Associations of Plasma Trimethylamine N-Oxide-Related Metabolites with the Development and Progression of Albuminuria

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Wang, Meng, Tufts University, Boston, Massachusetts, United States
  • Tang, W.H. Wilson, Cleveland Clinic, Cleveland, Ohio, United States
  • Li, Xinmin S., Cleveland Clinic, Cleveland, Ohio, United States
  • De Oliveira Otto, Marcia C., The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas, United States
  • Lemaitre, Rozenn, University of Washington, Seattle, Washington, United States
  • Fretts, Amanda M., University of Washington, Seattle, Washington, United States
  • Nemet, Ina, Cleveland Clinic, Cleveland, Ohio, United States
  • Sotoodehnia, Nona, University of Washington, Seattle, Washington, United States
  • Budoff, Matthew Jay, The Lundquist Institute, Torrance, California, United States
  • Didonato, Joseph A., Cleveland Clinic, Cleveland, Ohio, United States
  • Wang, Zeneng, Cleveland Clinic, Cleveland, Ohio, United States
  • Sarnak, Mark J., Tufts Medical Center, Boston, Massachusetts, United States
  • Mozaffarian, Dariush, Tufts University, Boston, Massachusetts, United States
  • Hazen, Stanley L., Cleveland Clinic, Cleveland, Ohio, United States
Background

Trimethylamine N-oxide (TMAO) is a gut-microbiota generated metabolite of dietary choline and carnitine. In animal models, TMAO increases albuminuria, an early, sensitive marker of kidney damage. Yet, little is known about TMAO and albuminuria in humans. We investigated prospective associations of plasma TMAO and its two microbiome-derived intermediates, crotonobetaine and γ-butyrobetaine, with the development and progression of albuminuria.

Methods

We included 6,101 US adults with normal (<30mg/g) baseline urine albumin to creatinine ratio (ACR) from the Multi-ethnic Study of Atherosclerosis, a community-based cohort. TMAO-related metabolites were measured using mass spectrometry at baseline and year 5. ACR levels were measured up to 4 times during follow-up. Time-varying Cox models related serial TMAO measures to elevated albuminuria, defined as the first occurrence of ACR ≥ 30 mg/g, adjusting for sociodemographic, lifestyle, diet, and CVD risk factors. Linear mixed models related serial TMAO measures to annualized ACR changes in 6,319 participants with at least one follow-up ACR measure (no exclusions for baseline ACR levels), adjusting for baseline ACR and other covariates.

Results

During a median follow-up of 16 years, 995 participants developed elevated albuminuria. Higher levels of TMAO and crotonobetaine, but not γ-butyrobetaine, associated with higher risk of elevated albuminuria (Figure). All three metabolites positively associated with annualized ACR increase (5th vs. 1st quintile [95%CI] =3.54 [1.10, 5.98], 4.28 [1.89, 6.67], and 4.49 [1.36, 7.61] mg/g per year, respectively).

Conclusion

In a multi-ethnic, community-based cohort of US adults, higher levels of gut microbiota-generated TMAO-related metabolites were associated with elevated albuminuria and its progression.

Multivariable-adjusted relationship of plasma levels of TMAO (left), crotonobetaine (middle), and γ-butyrobetaine (right) with the risk of elevated albuminuria

Funding

  • Private Foundation Support