{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:15:07Z","timestamp":1793085307355,"version":"4.5.0"},"reference-count":75,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Emerging evidence supports the beneficial effects of dietary fiber supplementation in alleviating gut dysbiosis, which leads to a reduction in uremic toxins and inflammatory markers in chronic kidney disease (CKD) patients. However, current evidence-based renal nutrition guidelines do not provide recommendations regarding dietary fiber intake. We performed a systematic review and meta-analysis to investigate and highlight the effects of dietary fiber supplementation on modulating uremic toxins and inflammatory markers in individuals with CKD, with or without dialysis. The eligible randomized controlled trials (RCTs) were identified from PubMed, Scopus, and Cochrane Central Register of Controlled trials until 27 November 2024. The results were synthesized using a random-effects model and presented as standardized mean differences (SMDs) with a 95% confidence interval (CI). A total of 21 studies with 700 patients were included. When compared with the control group, dietary fiber supplementation ranging from 6 to 50 g\/day, for typically more than 4 weeks, could significantly reduce the levels of serum uremic toxins, including p-cresyl sulfate, indoxyl sulfate, and blood urea nitrogen (SMD \u22120.22, \u22120.34, \u22120.25, respectively, with p-values &lt; 0.05), as well as biomarkers of inflammation, including interleukin-6 and tumor necrosis factor alpha (SMD \u22120.44, \u22120.34, respectively, with p-values &lt; 0.05). These beneficial effects were consistent across different types of fibers and CKD status (with or without dialysis). However, no significant reduction in serum trimethylamine N-oxide, uric acid, and high-sensitivity C-reactive protein levels was observed with dietary fiber intervention. This study would pave the way for prioritizing dietary quality, particularly a fiber-rich diet, beyond the traditional focus on the quantities of protein, energy, and electrolyte restrictions among individuals with CKD.<\/jats:p>","DOI":"10.3390\/toxins17020057","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T11:38:49Z","timestamp":1737977929000},"page":"57","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-6159","authenticated-orcid":false,"given":"Wannasit","family":"Wathanavasin","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Nephrology Unit, Department of Medicine, Charoenkrung Pracharak Hospital, Bangkok Metropolitan Administration, Bangkok 10120, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":false,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charat","family":"Thongprayoon","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3346-7040","authenticated-orcid":false,"given":"Tibor","family":"F\u00fcl\u00f6p","sequence":"additional","affiliation":[{"name":"Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, USA"},{"name":"Division of Nephrology, Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.3945\/ajcn.112.036418","article-title":"Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: Reconciling low protein intake with nutritional therapy","volume":"97","author":"Kovesdy","year":"2013","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.2478\/abm-2024-0002","article-title":"Plant-based diets in patients with chronic kidney disease","volume":"18","author":"Wathanavasin","year":"2024","journal-title":"Asian Biomed."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/ckj\/sfab169","article-title":"Fiber intake and health in people with chronic kidney disease","volume":"15","author":"Su","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_4","unstructured":"Ing. Romina Alina Vlaic, M., and Crina Carmen, M. (2024). Dietary Fibers and Their Importance in the Diet. New Insights in Dietary Fibers, IntechOpen. Chapter 1."},{"key":"ref_5","first-page":"1462","article-title":"Scientific opinion on dietary reference values for carbohydrates and dietary fibre","volume":"8","author":"Agostoni","year":"2010","journal-title":"EFSA J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"821","DOI":"10.3945\/jn.109.104497","article-title":"Intestinal nitrogen recycling and utilization in health and disease","volume":"139","author":"Bergen","year":"2009","journal-title":"J. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/B978-0-12-800100-4.00003-9","article-title":"The role of short-chain fatty acids in health and disease","volume":"121","author":"Tan","year":"2014","journal-title":"Adv. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1161\/CIRCRESAHA.116.305360","article-title":"Gut microbiota-dependent trimethylamine N-oxide (TMAO) pathway contributes to both development of renal insufficiency and mortality risk in chronic kidney disease","volume":"116","author":"Tang","year":"2015","journal-title":"Circ. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1159\/000360010","article-title":"Expansion of urease- and uricase-containing, indole- and p-cresol-forming and contraction of short-chain fatty acid-producing intestinal microbiota in ESRD","volume":"39","author":"Wong","year":"2014","journal-title":"Am. J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lin, C.J., Wu, V., Wu, P.C., and Wu, C.J. (2015). Meta-Analysis of the Associations of p-Cresyl Sulfate (PCS) and Indoxyl Sulfate (IS) with Cardiovascular Events and All-Cause Mortality in Patients with Chronic Renal Failure. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0132589"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rapa, S.F., Di Iorio, B.R., Campiglia, P., Heidland, A., and Marzocco, S. (2019). Inflammation and Oxidative Stress in Chronic Kidney Disease-Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21010263"},{"key":"ref_12","first-page":"1363","article-title":"Effects of fermentable dietary fiber supplementation on oxidative and inflammatory status in hemodialysis patients","volume":"8","author":"Xie","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1038\/ki.2011.355","article-title":"High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease","volume":"81","author":"Krishnamurthy","year":"2012","journal-title":"Kidney Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4932","DOI":"10.1039\/C8FO01917G","article-title":"Association of dietary fiber intake with hyperuricemia in U.S. adults","volume":"10","author":"Sun","year":"2019","journal-title":"Food Funct."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhu, Q., Yu, L., Li, Y., Man, Q., Jia, S., Zhou, Y., Zuo, H., and Zhang, J. (2022). Association between Dietary Fiber Intake and Hyperuricemia among Chinese Adults: Analysis of the China Adult Chronic Disease and Nutrition Surveillance (2015). Nutrients, 14.","DOI":"10.3390\/nu14071433"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.jada.2008.08.007","article-title":"Position of the American Dietetic Association: Health implications of dietary fiber","volume":"108","author":"Slavin","year":"2008","journal-title":"J. Am. Diet. Assoc."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kwon, Y.J., Lee, H.S., Park, G.E., and Lee, J.W. (2022). Association Between Dietary Fiber Intake and All-Cause and Cardiovascular Mortality in Middle Aged and Elderly Adults With Chronic Kidney Disease. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.863391"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1093\/ajcn\/63.3.392","article-title":"Supplementation with gum arabic fiber increases fecal nitrogen excretion and lowers serum urea nitrogen concentration in chronic renal failure patients consuming a low-protein diet","volume":"63","author":"Bliss","year":"1996","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Poesen, R., Evenepoel, P., de Loor, H., Delcour, J.A., Courtin, C.M., Kuypers, D., Augustijns, P., Verbeke, K., and Meijers, B. (2016). The Influence of Prebiotic Arabinoxylan Oligosaccharides on Microbiota Derived Uremic Retention Solutes in Patients with Chronic Kidney Disease: A Randomized Controlled Trial. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153893"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1093\/ndt\/gfy171","article-title":"Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: A randomized controlled trial","volume":"34","author":"Ramos","year":"2019","journal-title":"Nephrol. Dial. Transpl."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ebrahim, Z., Proost, S., Tito, R.Y., Raes, J., Glorieux, G., Moosa, M.R., and Blaauw, R. (2022). The Effect of \u00df-Glucan Prebiotic on Kidney Function, Uremic Toxins and Gut Microbiome in Stage 3 to 5 Chronic Kidney Disease (CKD) Predialysis Participants: A Randomized Controlled Trial. Nutrients, 14.","DOI":"10.3390\/nu14040805"},{"key":"ref_23","first-page":"819","article-title":"Low-protein diet supplemented with inulin lowers protein-bound toxin levels in patients with stage 3b-5 chronic kidney disease: A randomized controlled study","volume":"40","author":"Chang","year":"2023","journal-title":"Nutr. Hosp."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Headley, S.A., Chapman, D.J., Germain, M.J., Evans, E.E., Madsen, K.L., Miele, E.M., Kirton, K., Loseke, J., Cornelius, A., and Martin, B. (2024). Effects of High Amylose-Resistant Starch on Gut Microbiota and Uremic Toxin Levels in Patients with Stage-G3a-G4 Chronic Kidney Disease: A Randomized Trial. J. Ren. Nutr.","DOI":"10.1053\/j.jrn.2024.09.005"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"106181","DOI":"10.1016\/j.jff.2024.106181","article-title":"Effect of soluble dietary fiber on gut microbiota and derived metabolites in stage 3 to 5 chronic kidney disease patients: A randomized controlled trial","volume":"116","author":"Cui","year":"2024","journal-title":"J. Funct. Foods"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/14786410500463544","article-title":"The effects of gum arabic oral treatment on the metabolic profile of chronic renal failure patients under regular haemodialysis in Central Sudan","volume":"22","author":"Ali","year":"2008","journal-title":"Nat. Prod. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.2215\/CJN.00490114","article-title":"Effect of increasing dietary fiber on plasma levels of colon-derived solutes in hemodialysis patients","volume":"9","author":"Sirich","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"6508","DOI":"10.1039\/C8FO01876F","article-title":"Could resistant starch supplementation improve inflammatory and oxidative stress biomarkers and uremic toxins levels in hemodialysis patients? A pilot randomized controlled trial","volume":"9","author":"Esgalhado","year":"2018","journal-title":"Food Funct."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12986-019-0343-x","article-title":"Effects of fermentable high fiber diet supplementation on gut derived and conventional nitrogenous product in patients on maintenance hemodialysis: A randomized controlled trial","volume":"16","author":"Khosroshahi","year":"2019","journal-title":"Nutr. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/hdi.12753","article-title":"Amylose resistant starch (HAM-RS2) supplementation increases the proportion of Faecalibacterium bacteria in end-stage renal disease patients: Microbial analysis from a randomized placebo-controlled trial","volume":"23","author":"Laffin","year":"2019","journal-title":"Hemodial. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1039\/C9FO02939G","article-title":"Resistant starch type-2 enriched cookies modulate uremic toxins and inflammation in hemodialysis patients: A randomized, double-blind, crossover and placebo-controlled trial","volume":"11","author":"Esgalhado","year":"2020","journal-title":"Food Funct."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1053\/j.jrn.2020.10.003","article-title":"Effect of Dietary Inulin Supplementation on the Gut Microbiota Composition and Derived Metabolites of Individuals Undergoing Hemodialysis: A Pilot Study","volume":"31","author":"Biruete","year":"2021","journal-title":"J. Ren. Nutr."},{"key":"ref_33","first-page":"788","article-title":"Resistant Starch Type-2 Supplementation Does Not Decrease Trimethylamine N-Oxide (TMAO) Plasma Level in Hemodialysis Patients","volume":"41","author":"Kemp","year":"2022","journal-title":"J. Am. Nutr. Assoc."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Fatani, A.M.N., Suh, J.H., Auger, J., Alabasi, K.M., Wang, Y., Segal, M.S., and Dahl, W.J. (2023). Pea hull fiber supplementation does not modulate uremic metabolites in adults receiving hemodialysis: A randomized, double-blind, controlled trial. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1179295"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"60","DOI":"10.3747\/pdi.2014.00015","article-title":"Effects of Fructo-Oligosaccharide Supplementation on Constipation in Elderly Continuous Ambulatory Peritoneal Dialysis Patients","volume":"36","author":"Meksawan","year":"2016","journal-title":"Perit. Dial. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1093\/ajcn\/nqz337","article-title":"Inulin-type fructan intervention restricts the increase in gut microbiome-generated indole in patients with peritoneal dialysis: A randomized crossover study","volume":"111","author":"Li","year":"2020","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"de Andrade, L.S., Sard\u00e1, F.A.H., Pereira, N.B.F., Teixeira, R.R., Rodrigues, S.D., de Lima, J.D., Dalboni, M.A., Aoike, D.T., Nakao, L.S., and Cuppari, L. (2021). Effect of Unripe Banana Flour on Gut-Derived Uremic Toxins in Individuals Undergoing Peritoneal Dialysis: A Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. Nutrients, 13.","DOI":"10.3390\/nu13020646"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s00394-021-02669-y","article-title":"Inulin-type prebiotics reduce serum uric acid levels via gut microbiota modulation: A randomized, controlled crossover trial in peritoneal dialysis patients","volume":"61","author":"He","year":"2022","journal-title":"Eur. J. Nutr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e2200531","DOI":"10.1002\/mnfr.202200531","article-title":"The Effect of Inulin-Type Fructans on Plasma Trimethylamine N-Oxide Levels in Peritoneal Dialysis Patients: A Randomized Crossover Trial","volume":"67","author":"Xiong","year":"2023","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Stavropoulou, E., Kantartzi, K., Tsigalou, C., Konstantinidis, T., Romanidou, G., Voidarou, C., and Bezirtzoglou, E. (2020). Focus on the Gut-Kidney Axis in Health and Disease. Front. Med., 7.","DOI":"10.3389\/fmed.2020.620102"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Lauriola, M., Farr\u00e9, R., Evenepoel, P., Overbeek, S.A., and Meijers, B. (2023). Food-Derived Uremic Toxins in Chronic Kidney Disease. Toxins, 15.","DOI":"10.3390\/toxins15020116"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.trsl.2016.04.007","article-title":"Gut microbiome in chronic kidney disease: Challenges and opportunities","volume":"179","author":"Nallu","year":"2017","journal-title":"Transl. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1161\/CIRCRESAHA.123.321763","article-title":"Role of the Microbiome in Gut-Heart-Kidney Cross Talk","volume":"132","author":"Glorieux","year":"2023","journal-title":"Circ. Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Li, Q., Zhang, S., Wu, Q.J., Xiao, J., Wang, Z.H., Mu, X.W., Zhang, Y., Wang, X.N., You, L.L., and Wang, S.N. (2022). Serum total indoxyl sulfate levels and all-cause and cardiovascular mortality in maintenance hemodialysis patients: A prospective cohort study. BMC Nephrol., 23.","DOI":"10.1186\/s12882-022-02862-z"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"662","DOI":"10.5114\/aoms.2013.36901","article-title":"Serum p-cresyl sulfate predicts cardiovascular disease and mortality in elderly hemodialysis patients","volume":"9","author":"Lin","year":"2013","journal-title":"Arch. Med. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/j.1525-139X.2009.00576.x","article-title":"Protein-bound toxins\u2014Update 2009","volume":"22","author":"Dou","year":"2009","journal-title":"Semin. Dial."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1016\/j.clnu.2018.09.015","article-title":"Association between fibre intake and indoxyl sulphate\/P-cresyl sulphate in patients with chronic kidney disease: Meta-analysis and systematic review of experimental studies","volume":"38","author":"Wu","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1093\/advances\/nmaa109","article-title":"Perspective: Design and Conduct of Human Nutrition Randomized Controlled Trials","volume":"12","author":"Lichtenstein","year":"2021","journal-title":"Adv. Nutr."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Zhou, Z., Jin, H., Ju, H., Sun, M., Chen, H., and Li, L. (2022). Circulating Trimethylamine-N-Oxide and Risk of All-Cause and Cardiovascular Mortality in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Front. Med., 9.","DOI":"10.3389\/fmed.2022.828343"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11883-021-00910-x","article-title":"Trimethylamine N-oxide (TMAO), diet and cardiovascular disease","volume":"23","author":"Thomas","year":"2021","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Gruppen, E.G., Garcia, E., Connelly, M.A., Jeyarajah, E.J., Otvos, J.D., Bakker, S.J., and Dullaart, R.P. (2017). TMAO is associated with mortality: Impact of modestly impaired renal function. Sci. Rep., 7.","DOI":"10.1038\/s41598-017-13739-9"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Miao, L., Du, J., Chen, Z., Shi, D., and Qu, H. (2021). Effects of microbiota-driven therapy on circulating trimethylamine-N-oxide metabolism: A Systematic review and meta-analysis. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.710567"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1515\/cclm-2016-0374","article-title":"Intra-individual variation of plasma trimethylamine-N-oxide (TMAO), betaine and choline over 1 year","volume":"55","author":"Rohrmann","year":"2017","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e0094521","DOI":"10.1128\/msystems.00945-21","article-title":"Higher Trimethylamine-N-Oxide Plasma Levels with Increasing Age Are Mediated by Diet and Trimethylamine-Forming Bacteria","volume":"6","author":"Rath","year":"2021","journal-title":"mSystems"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1053\/j.ajkd.2015.09.027","article-title":"Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target","volume":"67","author":"Ramezani","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Ikee, R., Sasaki, N., Yasuda, T., and Fukazawa, S. (2020). Chronic Kidney Disease, Gut Dysbiosis, and Constipation: A Burdensome Triplet. Microorganisms, 8.","DOI":"10.3390\/microorganisms8121862"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/j.1365-2672.1996.tb04331.x","article-title":"Enumeration of human colonic bacteria producing phenolic and indolic compounds: Effects of pH, carbohydrate availability and retention time on dissimilatory aromatic amino acid metabolism","volume":"81","author":"Smith","year":"1996","journal-title":"J. Appl. Bacteriol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1007\/s002489900020","article-title":"Formation of Phenolic and Indolic Compounds by Anaerobic Bacteria in the Human Large Intestine","volume":"33","author":"Smith","year":"1997","journal-title":"Microb. Ecol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"3994","DOI":"10.1080\/10408398.2021.1996331","article-title":"Dietary strategies for gut-derived protein-bound uremic toxins and cardio-metabolic risk factors in chronic kidney disease: A focus on dietary fibers","volume":"63","author":"Melekoglu","year":"2023","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ekir.2022.11.016","article-title":"Uric Acid and Chronic Kidney Disease: Still More to Do","volume":"8","author":"Johnson","year":"2023","journal-title":"Kidney Int. Rep."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"184","DOI":"10.3177\/jnsv.48.184","article-title":"Dietary fiber suppresses elevations of uric acid and allantoin in serum and urine induced by dietary RNA and increases its excretion to feces in rats","volume":"48","author":"Koguchi","year":"2002","journal-title":"J. Nutr. Sci. Vitaminol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1024\/0300-9831.74.4.253","article-title":"Dietary fiber suppresses elevation of uric acid and urea nitrogen concentrations in serum of rats with renal dysfunction induced by dietary adenine","volume":"74","author":"Koguchi","year":"2004","journal-title":"Int. J. Vitam. Nutr. Res."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1933","DOI":"10.1002\/art.39115","article-title":"Food Sources of Protein and Risk of Incident Gout in the Singapore Chinese Health Study","volume":"67","author":"Teng","year":"2015","journal-title":"Arthritis Rheumatol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2180373","DOI":"10.1155\/2018\/2180373","article-title":"Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome","volume":"2018","author":"Mihai","year":"2018","journal-title":"J. Immunol. Res."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Wathanavasin, W., Banjongjit, A., Avihingsanon, Y., Praditpornsilpa, K., Tungsanga, K., Eiam-Ong, S., and Susantitaphong, P. (2022). Prevalence of Sarcopenia and Its Impact on Cardiovascular Events and Mortality Among Dialysis Patients: A Systematic Review and Meta-Analysis. Nutrients, 14.","DOI":"10.3390\/nu14194077"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.2337\/diacare.28.5.1022","article-title":"Dietary glycemic index, glycemic load, cereal fiber, and plasma adiponectin concentration in diabetic men","volume":"28","author":"Qi","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/00004836-200603000-00015","article-title":"Colonic health: Fermentation and short chain fatty acids","volume":"40","author":"Wong","year":"2006","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.nut.2008.04.005","article-title":"Association between dietary fiber and markers of systemic inflammation in the Women\u2019s Health Initiative Observational Study","volume":"24","author":"Ma","year":"2008","journal-title":"Nutrition"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/ije\/dyp345","article-title":"Meta-analyses involving cross-over trials: Methodological issues","volume":"40","author":"Stedman","year":"2011","journal-title":"Int. J. Epidemiol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jclinepi.2020.06.015","article-title":"The revised Cochrane risk of bias tool for randomized trials (RoB 2) showed low interrater reliability and challenges in its application","volume":"126","author":"Minozzi","year":"2020","journal-title":"J. Clin. Epidemiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med","volume":"14","author":"Wan","year":"2014","journal-title":"Res. Methodol."},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Borenstein, M., Hedges, L.V., Higgins, J.P., and Rothstein, H.R. (2021). Introduction to Meta-Analysis, John Wiley & Sons.","DOI":"10.1002\/9781119558378"},{"key":"ref_74","unstructured":"Holger Sch\u00fcnemann, J.B., Guyatt, G., and Oxman, A. (2024, August 03). Handbook for Grading the Quality of Evidence and the Strength of Recommendations Using the GRADE Approach. Available online: https:\/\/gdt.gradepro.org\/app\/handbook\/handbook.html."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/2\/57\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:28Z","timestamp":1759919788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/17\/2\/57"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":75,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["toxins17020057"],"URL":"https:\/\/doi.org\/10.3390\/toxins17020057","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}