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Effect of cranberry supplementation on toxins produced by the gut microbiota in chronic kidney disease patients: a pilot randomized placebo-controlled trial.

Teixeira, K. T. R.; Moreira, L. de S. G.; Borges, N. A.; Brum, I.; Paiva, B. R. de; Alvarenga, L.; Nakao, L. S.; Leal, V. de O.; Carraro-Eduardo, J. C.; Rodrigues, S. D.; Lima, J. D.; Ribeiro-Alves, M.; Mafra, D.
Clinical Nutrition ESPEN; 2022. 47:63-69.

Background & aims: Patients with Chronic Kidney Disease (CKD) have an imbalance in the gut microbiota that can lead to increase levels of lipopolysaccharides (LPS) and uremic toxins such as indoxyl sulfate (IS), p-cresyl sulfate (p-CS), and indole-3 acetic acid (IAA). Among the therapeutic options for modulating gut microbiota are the bioactive compounds such as polyphenols present in cranberry, fruit with potential antioxidant and anti-inflammatory effects. This clinical trial focuses on evaluating the effects of supplementation with a dry extract of cranberry on plasma levels of LPS and uremic toxins in non-dialysis CKD patients. Methods: It was a randomized, double-blind, placebo-controlled study. Patients were randomized into two groups: the cranberry group received 500 mg of dry cranberry extract (2 times daily), and the placebo group received 500 mg of corn starch (2 times daily) for two months. LPS plasma levels were evaluated by enzyme-linked immunosorbent assay (ELISA) and uremic toxins (IS, p-CS, and IAA) by high-performance liquid chromatography-fluorescence detection. Anthropometric measurements and food intake using the 24-h food recall technique were also evaluated before and after the intervention. Results: Twenty-five participants completed two months of supplementation: 12 patients in the cranberry group (8 women, 56.7 +or- 7.5 years, estimated glomerular filtration rate (eGFR) of 39.2 +or- 21.9 mL/min); 13 patients in the placebo group (9 women, 58.8 +or- 5.1 years, eGFR of 39.7 +or- 12.9 mL/min). As expected, there was a negative association between glomerular filtration rate and p-CS and IS plasma levels at the baseline. No change was observed in the uremic toxins and LPS levels. Conclusion: Cranberry dry extract supplementation for two months did not reduce the LPS and uremic toxins plasma levels produced by the gut microbiota in non-dialysis CKD patients.