{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:15:06Z","timestamp":1793085306669,"version":"4.5.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R21DK108093"],"award-info":[{"award-number":["R21DK108093"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["UL1TR000001"],"award-info":[{"award-number":["UL1TR000001"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Colorado GI and Liver Innate Immune Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent evidence suggests the systemic accumulation of by-products of gut microbes contributes to cardiovascular morbidity in patients with CKD. Limiting the generation of toxic bacterial by-products by manipulating the intestinal microbiota may be a novel strategy for reducing cardiovascular disease in CKD. Rifaximin is a minimally absorbed, oral antibiotic that targets intestinal pathogens and is commonly used as chronic therapy for the prevention of encephalopathy in patients with cirrhosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a randomized, double-blinded, placebo-controlled trial to determine the effect of a 10-day course of oral rifaximin 550 mg BID versus placebo on circulating concentrations of gut-derived cardiovascular toxins and proinflammatory cytokines in patients with stage 3\u20135 CKD (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =38). The primary clinical outcome was change in serum trimethylamine\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      -oxide (TMAO) concentrations from baseline to study end. Secondary outcomes included change in serum concentrations of p-cresol sulfate, indoxyl sulfate, kynurenic acid, deoxycholic acid, and inflammatory cytokines (C-reactive protein, IL-6, IL-1\n                      <jats:italic toggle=\"yes\">\u03b2<\/jats:italic>\n                      ), and change in composition and diversity of fecal microbiota.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 19 patients were randomized to each of the rifaximin and placebo arms, with\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =17 and\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =14 completing both study visits in these respective groups. We observed no difference in serum TMAO change (post-therapy minus baseline TMAO) between the rifaximin and placebo groups (mean TMAO change \u22123.9\u00b115.4 for rifaximin versus 0.5\u00b19.5 for placebo,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.49). Similarly, we found no significant change in serum concentrations for p-cresol sulfate, indoxyl sulfate, kynurenic acid, deoxycholic acid, and inflammatory cytokines. We did observe differences in colonic bacterial communities, with the rifaximin group exhibiting significant decreases in bacterial richness (Chao1,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02) and diversity (Shannon H,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.05), along with altered abundance of several bacterial genera.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Short-term rifaximin treatment failed to reduce gut-derived cardiovascular toxins and inflammatory cytokines in patients with CKD.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Clinical Trial registry name and registration number<\/jats:bold>\n                      Rifaximin Therapy in Chronic Kidney Disease, NCT02342639\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.34067\/kid.0003942020","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T21:45:11Z","timestamp":1599255911000},"page":"1206-1216","source":"Crossref","is-referenced-by-count":24,"title":["Randomized, Placebo-Controlled Trial of Rifaximin Therapy for Lowering Gut-Derived Cardiovascular Toxins and Inflammation in CKD"],"prefix":"10.34067","volume":"1","clinical-trial-number":[{"clinical-trial-number":"nct02342639","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Cassandra","family":"Kimber","sequence":"first","affiliation":[{"name":"The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiqin","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Jared 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Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Mahnken","sequence":"additional","affiliation":[{"name":"The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S.","family":"Yu","sequence":"additional","affiliation":[{"name":"The Jared Grantham Kidney Institute, University of Kansas Medical Center, Kansas City, Kansas"},{"name":"Division of Nephrology and Hypertension, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N.","family":"Hoofnagle","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Ir","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Robertson","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Chonchol","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, University of Colorado 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