Böbrek Sağlığı: Posa Alımı Yararlı mı?

Yıl 2024, , 223 - 234, 31.05.2024

Nisa Nur Ayhanci , Yasemin Beyhan

https://doi.org/10.52369/togusagbilderg.1273492

Öz

Öz
Diyet kısıtlamaları nedeniyle kronik böbrek hastalarının posa tüketimi oldukça düşük olmaktadır. Bununla birlikte çalışmalar yüksek miktarda posa tüketiminin böbrek sağlığını koruduğunu, kronik böbrek hastalığının ilerlemesi ve hastalık ile ilişkili komplikasyonları önleyebileceğini göstermektedir. Mevcut kanıtlar yeterli miktar ve çeşitlilikte tüketilen posanın dışkılamayı iyileştirerek, mikrobiyatayı olumlu yönde modüle ederek ve bağırsak bütünlüğünü iyleştirerek üremik toksinlerin serum seviyelerini ve inflamasyonu düşürebildiğini böylelikle böbrek sağlığını ve genel sağlığı olumlu yönde etkileyebildiğini göstermektedir. Bu derleme, konu ile ilgili mevcut kanıtları özetlemeyi ve kronik böbrek hastalığı olan hastalarda böbrek sağlığı ve hastalık komplikasyonlarını iyileştirmek için diyet posası alımını artırma olanaklarını tartışmaktadır. Mevcut kanıtlara dayanarak, kronik böbrek hastalığı olan hastalarda yeterli miktar ve çeşitlilikte posa tüketimi önerilmektedir. Bu tür hastaların böbrek sağlığı alanında uzmanlaşmış bir diyetisyene yönlendirilmesi hastalığın tıbbi beslenme tedavisi açısından önemlidir.

Anahtar Kelimeler: Kronik böbrek hastalığı, posa, mikrobiyata.
Abstract

Due to dietary restrictions, the fiber consumption of chronic kidney patients is very low. However, studies show that high fiber consumption protects kidney health and can prevent progression of chronic kidney disease and disease-related complications. Current evidence shows that fiber consumed in sufficient quantity and variety can reduce serum levels of uremic toxins and inflammation by improving defecation, positively modulating the microbiota, and improving gut integrity, thereby positively affecting kidney health and overall health. This review summarizes the available evidence on the subject and discusses the possibilities of increasing dietary fiber intake to improve kidney health and disease complications in patients with chronic kidney disease. Based on the available evidence, adequate and varied fiber consumption is recommended in patients with chronic kidney disease. Referring such patients to a dietitian specialized in kidney health is important in terms of medical nutrition therapy of the disease.

Keywords: Chronic kidney disease, fiber, microbiota.

Anahtar Kelimeler

kronik böbrek yetmezliği, posa, mikrobiyota

Kaynakça

• 1. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. (2018) Türkiye Böbrek Hastalıkları Önleme ve Kontrol Programı (2018-2023). Ankara: T.C. Sağlık Bakanlığı Yayın No : 1117
• 2. Süleymanlar G, Utaş C, Arinsoy T, Ateş K, Altun B, Altiparmak MR ve diğ. A population-based survey of Chronic Renal Disease In Turkey-the CREDIT study. Nephrology Dialysis Transplantation, 2011;26(6):1862–1871.
• 3. Türkiye 2021 Yılı Ulusal Nefroloji, Diyaliz ve Transplantasyon Kayıt Sistemi Raporu. Türkiye’de Nefroloji, Diyaliz ve Transplantasyon. T.C. Sağlık Bakanlığı ve Türk Nefroloji Derneği Ortak Raporu ISBN 978-605-62465-0-0. Erişim adresi: https://nefroloji.org.tr/uploads/files/REGISTRY_2022.PDF
• 4. Yıldız E. Kronik böbrek yetmezliği ve beslenme. 1. baskı. Ed. Yıldız E. Ankara: Klasmat Matbaacılık; 2008
• 5. Ikizler TA, Burrowes JD, Byham-Gray LD, Campbell KL, Carrero J-J, Chan W ve diğ. KDOQI clinical practice guideline for nutrition in CKD: 2020. American Journal of Kidney Diseases. 2020;76(3):S1–S107.
• 6. Luis D, Zlatkis K, Comenge B, García Z, Navarro JF, Lorenzo V ve diğ. Dietary Quality and Adherence to Dietary Recommendations in Patients Undergoing Hemodialysis. Journal of Renal Nutrition. 2016;26(3):190–195.
• 7. Threapleton DE, Greenwood DC, Evans CEL, Cleghorn CL, Nykjaer C, Woodhead C ve diğ. Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. Bmj. 2013;347.
• 8. Reynolds A, Mann J, Cummings J, Winter N, Mete E, Te Morenga L. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. The Lancet. 2019;393(10170):434–445.
• 9. Stephen AM, Champ MMJ, Cloran SJ, Fleith M, Van Lieshout L, Mejborn H ve diğ. Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health. Nutrition research reviews. 2017;30(2):149–190.
• 10. Su G, Qin X, Yang C, Sabatino A, Kelly JT, Avesani CM ve diğ. Fiber intake and health in people with chronic kidney disease. Clinical Kidney Jounal. 2022;15(2):213–225.
• 11. Demirci BG, Tutal E, Eminsoy IO, Kulah E, Sezer S. Dietary fiber intake: its relation with glycation end products and arterial stiffness in end-stage renal disease patients. Journal of Renal Nutrition. 2019;29(2):136–142.
• 12. Li L, Xiong Q, Zhao J, Lin X, He S, Wu N ve diğ. Inulin-type fructan intervention restricts the increase in gut microbiome–generated indole in patients with peritoneal dialysis: A randomized crossover study. The American Journal of Clinical Nutrition. 2020;111(5):1087–1099.
• 13. Wang AYM, Sea MMM, Ng K, Wang M, Chan IHS, Lam CWK ve diğ. Dietary fiber intake, myocardial injury, and major adverse cardiovascular events among end-stage kidney disease patients: a prospective cohort study. Kidney International Reports. 2019;4(6):814–823.
• 14. Agostoni CV, Bresson JL, Fairweather Tait S, Flynn A, Golly I, Korhonen H ve diğ. Scientific opinion on dietary reference values for carbohydrates and dietary fibre. EFSA Journal. 2010;8(3).
• 15. Wu Y, Qian Y, Pan Y, Li P, Yang J, Ye X ve diğ. Association between dietary fiber intake and risk of coronary heart disease: A meta-analysis. Clinical Nutrition. 2015;34(4):603–611.
• 16. Steffen LM, Jacobs Jr DR, Stevens J, Shahar E, Carithers T, Folsom AR. Associations of whole-grain, refined-grain, and fruit and vegetable consumption with risks of all-cause mortality and incident coronary artery disease and ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) Study. The American Journal of Clinical Nutrition. 2003;78(3):383–390.
• 17. Ning H, Van Horn L, Shay CM, Lloyd-Jones DM. Associations of dietary fiber intake with long-term predicted cardiovascular disease risk and C-reactive protein levels (from the National Health and Nutrition Examination Survey Data [2005–2010]). The American Journal of Cardiology. 2014;113(2):287–291.
• 18. Montonen J, Knekt P, Järvinen R, Aromaa A, Reunanen A. Whole-grain and fiber intake and the incidence of type 2 diabetes. The American Journal of Clinical Nutrition. 2003;77(3):622–629.
• 19. Anderson JW, Baird P, Davis RH, Ferreri S, Knudtson M, Koraym A ve diğ. Health benefits of dietary fiber. Nutrition Reviews. 2009;67(4):188–205.
• 20. Sun L, Zhang Z, Xu J, Xu G, Liu X. Dietary fiber intake reduces risk for Barrett’s esophagus and esophageal cancer. Critical Reviews in Food Science and Nutrition. 2017;57(13), 2749-2757.
• 21. Yang J, Wang HP, Zhou L, Xu CF. Effect of dietary fiber on constipation: a meta analysis. World Journal of Gastroenterology:WJG. 2012;18(48):7378.
• 22. Makki K, Deehan EC, Walter J, Bäckhed F. The impact of dietary fiber on gut microbiota in host health and disease. Cell Host Microbe. 2018;23(6):705–715.
• 23. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. The American Journal of Clinical Nutrition. 1999;69(1):30–42.
• 24. Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial. The Journal of Family Practice. 2002;51(4):369.
• 25. Anderson JW, Randles KM, Kendall CWC, Jenkins DJA. Carbohydrate and fiber recommendations for individuals with diabetes: a quantitative assessment and meta-analysis of the evidence. Journal of the American College of Nutrition. 2004;23(1):5–17.
• 26. Birketvedt GS, Shimshi M, Erling T, Florholmen J. Experiences with three different fiber supplements in weight reduction. Journal of Experimental and Clinical Research. 2005;11(1):15–18.
• 27. Watzl B, Girrbach S, Roller M. Inulin, oligofructose and immunomodulation. British Journal of Nutrition. 2005;93(S1):S49–S55.
• 28. Díaz-López A, Bulló M, Basora J, Martínez-González MÁ, Guasch-Ferré M, Estruch R ve diğ. Cross-sectional associations between macronutrient intake and chronic kidney disease in a population at high cardiovascular risk. Clinical Nutrition. 2013;32(4):606–612.
• 29. Krishnamurthy VMR, Wei G, Baird BC, Murtaugh M, Chonchol MB, Raphael KL ve diğ. High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease. Kidney International. 2012;81(3):300–306.
• 30. Xie LM, Ge YY, Huang X, Zhang YQ, Li JX. Effects of fermentable dietary fiber supplementation on oxidative and inflammatory status in hemodialysis patients. International Journal of Clinical and Experimental Medicine. 2015;8(1):1363.
• 31. Chiavaroli L, Mirrahimi A, Sievenpiper JL, Jenkins DJA, Darling PB. Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials. European Journal of Clinical Nutrition. 2015;69(7):761–768.
• 32. Evenepoel P, Meijers BK. Dietary fiber and protein: nutritional therapy in chronic kidney disease and beyond. Kidney International. 2012;81(3):227–229.
• 33. Mirmiran P, Yuzbashian E, Asghari G, Sarverzadeh S, Azizi F. Dietary fibre intake in relation to the risk of incident chronic kidney disease. British Journal of Nutrition. 2018;119(5):479–485.
• 34. Xu H, Huang X, Risérus U, Krishnamurthy VM, Cederholm T, Ärnlöv J ve diğ. Dietary fiber, kidney function, inflammation, and mortality risk. Clinical Journal of The American Society of Nephrology: CJASN. 2014;9(12):2104–2110.
• 35. Gopinath B, Harris DC, Flood VM, Burlutsky G, Brand-Miller J, Mitchell P. Carbohydrate nutrition is associated with the 5-year incidence of chronic kidney disease. The Journal of Nutrition. 2011;141(3):433–439.
• 36. Sabatino A, Regolisti G, Brusasco I, Cabassi A, Morabito S, Fiaccadori E. Alterations of intestinal barrier and microbiota in chronic kidney disease. Nephrology Dialysis Transplantation. 2015;30(6):924–933.
• 37. Wu M, Cai X, Lin J, Zhang X, Scott EM, Li X. Association between fibre intake and indoxyl sulphate/P-cresyl sulphate in patients with chronic kidney disease: Meta-analysis and systematic review of experimental studies. Clinical Nutrition. 2019;38(5):2016–2222.
• 38. Yang HL, Feng P, Xu Y, Hou YY, Ojo O, Wang XH. The role of dietary fiber supplementation in regulating uremic toxins in patients with chronic kidney disease: a meta-analysis of randomized controlled trials. Journal of Renal Nutrition. 2021;31(5):438–447.
• 39. Sirich TL, Plummer NS, Gardner CD, Hostetter TH, Meyer TW. Effect of increasing dietary fiber on plasma levels of colon-derived solutes in hemodialysis patients. Clinical Journal of The American Society of Nephrology: CJASN. 2014;9(9):1603.
• 40. Meijers BKI, De Preter V, Verbeke K, Vanrenterghem Y, Evenepoel P. p-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin. Nephrology Dialysis Transplantation. 2010;25(1):219–224.
• 41. Biruete A, Cross T-WL, Allen JM, Kistler BM, de Loor H, Evenepoel P ve diğ. Effect of dietary inulin supplementation on the gut microbiota composition and derived metabolites of individuals undergoing hemodialysis: a pilot study. Journal of Renal Nutrition. 2021;31(5):512–522.
• 42. Salmean YA, Segal MS, Palii SP, Dahl WJ. Fiber supplementation lowers plasma p-cresol in chronic kidney disease patients. Journal of Renal Nutrition. 2015;25(3):316–320.
• 43. Ramos CI, Armani RG, Canziani MEF, Dalboni MA, Dolenga CJR, Nakao LS ve diğ. Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial. Nephrology Dialysis Transplantation. 2019;34(11):1876–1884.
• 44. Yasuda G, Shibata K, Takizawa T, Ikeda Y, Tokita Y, Umemura S ve diğ. Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients. American Journal of Kidney Diseases. 2002;39(6):1292–9.
• 45. Dos Santos RG, Scatone NK, Malinovski J, Sczip AC, de Oliveira JC, Morais JG ve diğ. Higher frequency of fruit intake is associated with a lower risk of constipation in hemodialysis patients: a multicenter study. Journal of Renal Nutrition. 2021;31(1):85–89.
• 46. Viramontes-Hörner D, Márquez-Sandoval F, Martín-del-Campo F, Vizmanos-Lamotte B, Sandoval-Rodríguez A, Armendáriz-Borunda J ve diğ. Effect of a symbiotic gel (Lactobacillus acidophilus+ Bifidobacterium lactis+ inulin) on presence and severity of gastrointestinal symptoms in hemodialysis patients. Journal of Renal Nutrition. 2015;25(3):284–291.
• 47. Sutton D, Ovington S, Engel B. A multi‐centre, randomised trial to assess whether increased dietary fibre intake (using a fibre supplement or high‐fibre foods) produces healthy bowel performance and reduces laxative requirement in free living patients on peritoneal dialysis. Journal of Renal Care. 2014;40(3):157–163. 48. Salmean YA, Zello GA, Dahl WJ. Foods with added fiber improve stool frequency in individuals with chronic kidney disease with no impact on appetite or overall quality of life. BMC Research Notes. 2013;6, 1-5.
• 49. Vuksan V, Jenkins DJ, Spadafora P, Sievenpiper JL, Owen R, Vidgen E ve diğ. Konjac-mannan (glucomannan) improves glycemia and other associated risk factors for coronary heart disease in type 2 diabetes. A randomized controlled metabolic trial. Diabetes Care. 1999;22(6):913–919.
• 50. Streppel MT, Arends LR, van’t Veer P, Grobbee DE, Geleijnse JM. Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Archives of Internal Medicine. 2005;165(2):150–156.
• 51. Lin Z, Qin X, Yang Y, Huang Y, Wang J, Kong Y ve diğ. Higher dietary fiber intake is associated with lower cardiovascular disease mortality risk among maintenance hemodialysis patients: a multicenter prospective cohort study. The British Journal of Nutrition. 2021;1–25.
• 52. Xu X, Li Z, Chen Y, Liu X, Dong J. Dietary fibre and mortality risk in patients on peritoneal dialysis. The British Journal of Nutrition. 2019;122(9):996–1005.
• 53. Xu H, Rossi M, Campbell KL, Sencion GL, Ärnlöv J, Cederholm T ve diğ. Excess protein intake relative to fiber and cardiovascular events in elderly men with chronic kidney disease. Nutrition, Metabolism and Cardiovascular Diseases. 2016;26(7):597–602.
• 54. Kim Y, Je Y. Dietary fiber intake and total mortality: a meta-analysis of prospective cohort studies. American Journal of Epidemiology. 2014;180(6):565–573.
• 55. Veronese N, Solmi M, Caruso MG, Giannelli G, Osella AR, Evangelou E ve diğ. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. The American Journal of Clinical Nutrition. 2018;107(3):436–444.
• 56. Kelly JT, Palmer SC, Wai SN, Ruospo M, Carrero J-J, Campbell KL ve diğ. Healthy dietary patterns and risk of mortality and ESRD in CKD: a meta-analysis of cohort studies. Clinical Journal of The American Society of Nephrology: CJASN. 2017;12(2):272.
• 57. Türkiye Beslenme Rehberi (TÜBER). (2022). T.C Sağlık Bakanlığı Yayın No:1031, Ankara 2022.
• 58. Kızıltan G. Son dönem böbrek yetmezliğinde tıbbi beslenme tedavisi. Beslenme ve Diyet Dergisi. 2018;46:48–56.
• 59. Jones W L. Demineralization of a wide variety of foods for the renal patient. Journal of Renal Nutrition. 2001;11(2):90–96.
• 60. Martínez-Pineda M, Yagüe-Ruiz C, Caverni-Muñoz A, Vercet-Tormo A. Cooking legumes: a way for their inclusion in the renal patient diet. Journal of Renal Nutrition. 2019;29(2):118–125.
• 61. Burrowes JD, Ramer NJ. Removal of potassium from tuberous root vegetables by leaching. Journal of Renal Nutrition. 2006;16(4):304–11.
• 62. Smith EA, Macfarlane GT. Enumeration of human colonic bacteria producing phenolic and indolic compounds: effects of pH, carbohydrate availability and retention time on dissimilatory aromatic amino acid metabolism. Journal of Applied Bacteriology. 1996;81(3):288–302.
• 63. Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B ve diğ. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews. Gastroenterology and Hepatology. 2014:11(8), 506–514.