{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:11:10Z","timestamp":1793121070495,"version":"4.5.0"},"reference-count":55,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Western Sydney Local Health District Research Education Network","award":["2020"],"award-info":[{"award-number":["2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Declining kidney function contributes to the accumulation of uraemic toxins produced by gut microbiota, leading to the uraemic syndrome. This study aimed to identify associations between uraemic toxins, diet quality, symptoms and the gut microbiota in individuals initiating peritoneal dialysis. A cross-sectional analysis of baseline data from participants in a longitudinal study was conducted. Symptom scores using the Integrated Palliative Care Outcomes Scale-Renal were recorded. Plasma p-Cresyl sulfate, indoxyl sulfate and trimethylamine N-oxide were measured using liquid chromatography-mass spectrometry. Gut microbiota was determined using 16S rRNA sequencing. Multivariate linear models examined associations across the cohort. Data from 43 participants (mean age 61 \u00b1 13 years; 70% male; median eGFR 7 mL\/min\/1.73 m2) were analysed. Diabetes was the primary cause of kidney disease (51.2%). Patients were classified into \u2018high\u2019 (n = 18) and \u2018low\u2019 (n = 26) uraemic toxin groups using K-means clustering. The \u2018high\u2019 group had a lower eGFR (p &lt; 0.05) but no differences in diet quality or symptom scores. Significant differences in alpha and beta diversity were observed between the groups (p = 0.01). The \u2018high\u2019 group had increased Catenibacterium, Prevotella, Clostridia, and decreased Ruminococcus gnavus abundances. Multivariate models identified 32 genera associated with uraemic toxins, including positive associations of Oscillospiraceae UCG-002 and UCG-005 with p-cresyl sulfate, and negative associations with Actinomyces and Enterococcus. Patients with kidney failure initiating peritoneal dialysis have distinct uraemic toxin profiles, associated with differences in microbial diversity. This phenotype was also associated with differences in residual kidney function but not with diet or symptom severity. Longitudinal studies are required to determine causality and guide therapeutic interventions.<\/jats:p>","DOI":"10.3390\/toxins17070334","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T10:45:08Z","timestamp":1751366708000},"page":"334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Associations Between Uraemic Toxins and Gut Microbiota in Adults Initiating Peritoneal Dialysis"],"prefix":"10.3390","volume":"17","author":[{"given":"Philippa","family":"James","sequence":"first","affiliation":[{"name":"School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Stanford","sequence":"additional","affiliation":[{"name":"School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ojas V. A.","family":"Dixit","sequence":"additional","affiliation":[{"name":"School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia"},{"name":"Faculty of Science and Technology, University of Canberra, Canberra, ACT 2617, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Ann","family":"Nicdao","sequence":"additional","affiliation":[{"name":"Western Renal Services, Western Sydney and Nepean Blue Mountains Local Health Districts, Sydney, NSW 2750, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"McWhinney","sequence":"additional","affiliation":[{"name":"Analytical Chemistry Unit, Chemical Pathology, Pathology Queensland, Brisbane, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7648-007X","authenticated-orcid":false,"given":"Kamal","family":"Sud","sequence":"additional","affiliation":[{"name":"Western Renal Services, Western Sydney and Nepean Blue Mountains Local Health Districts, Sydney, NSW 2750, Australia"},{"name":"Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Ryan","sequence":"additional","affiliation":[{"name":"Western Renal Services, Western Sydney and Nepean Blue Mountains Local Health Districts, Sydney, NSW 2750, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Read","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia"},{"name":"Liver Immunology Group, Storr Liver Centre, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia"},{"name":"Blacktown-Mount Druitt Hospital, Blacktown, NSW 2148, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Golo","family":"Ahlenstiel","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia"},{"name":"Liver Immunology Group, Storr Liver Centre, Westmead Institute for Medical Research, Westmead, NSW 2145, Australia"},{"name":"Blacktown-Mount Druitt Hospital, Blacktown, NSW 2148, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5935-7328","authenticated-orcid":false,"given":"Kelly","family":"Lambert","sequence":"additional","affiliation":[{"name":"Health Innovations, University of Wollongong, Wollongong, NSW 2500, Australia"},{"name":"Kidney Lifestyle Research Group, University of Wollongong, Wollongong, NSW 2500, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Faculty of Science and Technology, University of Canberra, Canberra, ACT 2617, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Chau","sequence":"additional","affiliation":[{"name":"School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia"},{"name":"Western Renal Services, Western Sydney and Nepean Blue Mountains Local Health Districts, Sydney, NSW 2750, Australia"},{"name":"Blacktown-Mount Druitt Hospital, Blacktown, NSW 2148, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hill, N.R., Fatoba, S.T., Oke, J.L., Hirst, J.A., O\u2019Callaghan, C.A., Lasserson, D.S., and Hobbs, F.D.R. 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