Browsing by Author "Ebrahim, Zarina"

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    The Effect of ß-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
    (MDPI, 2022-02-14) Ebrahim, Zarina; Proost, Sebastian; Tito, Raul Yhossef; Raes, Jeroen; Glorieux, Griet; Moosa, Mohammed Rafique; Blaauw, Renee
    There is growing evidence that gut dysbiosis contributes to the progression of chronic kidney disease (CKD) owing to several mechanisms, including microbiota-derived uremic toxins, diet and immune-mediated factors. The aim of this study was to investigate the effect of a ß-glucan prebiotic on kidney function, uremic toxins and the gut microbiome in stage 3 to 5 CKD participants. Fifty-nine participants were randomized to either the ß-glucan prebiotic intervention group (n = 30) or the control group (n = 29). The primary outcomes were to assess kidney function (urea, creatinine and glomerular filtration rate), plasma levels of total and free levels of uremic toxins (p-cresyl sulfate (pCS), indoxyl-sulfate (IxS), p-cresyl glucuronide (pCG) and indoxyl 3-acetic acid (IAA) and gut microbiota using 16S rRNA sequencing at baseline, week 8 and week 14. The intervention group (age 40.6 ± 11.4 y) and the control group (age 41.3 ± 12.0 y) did not differ in age or any other socio-demographic variables at baseline. There were no significant changes in kidney function over 14 weeks. There was a significant reduction in uremic toxin levels at different time points, in free IxS at 8 weeks (p = 0.003) and 14 weeks (p < 0.001), free pCS (p = 0.006) at 14 weeks and total and free pCG (p < 0.001, p < 0.001, respectively) and at 14 weeks. There were no differences in relative abundances of genera between groups. Enterotyping revealed that the population consisted of only two of the four enterotypes: Bacteroides 2 and Prevotella. The redundancy analysis showed a few factors significantly affected the gut microbiome: these included triglyceride levels (p < 0.001), body mass index (p = 0.002), high- density lipoprotein (p < 0.001) and the prebiotic intervention (p = 0.002). The ß-glucan prebiotic significantly altered uremic toxin levels of intestinal origin and favorably affected the gut microbiome.
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    The effect of β-glucan prebiotic fibre (oats) on the gut microbiome of chronic kidney disease patients (Stage IV and V) and impact on kidney function
    (Stellenbosch : Stellenbosch University, 2022-04) Ebrahim, Zarina; Blaauw, Renée; Moosa, M. Rafique; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY: Background: Chronic kidney disease (CKD) is increasing in global prevalence and has many nutritional complications. Increasing evidence suggests that gut dysbiosis is involved in CKD progression through various mechanisms including intestinally derived uraemic toxins, dietary, and immune-mediated factors. Therefore, modulating the gut microbiome may improve outcomes in CKD. The aim of this research project was to investigate the effect of a ß-glucan prebiotic supplement on kidney outcomes, uraemic toxins and the gut microbiome in predialysis CKD participants. Methods: This study was a randomised controlled intervention study over 18 weeks, performed at Tygerberg Hospital predialysis clinic in Cape Town, South Africa. There was a pre-randomisation period of four weeks where participants were counselled on a CKD diet before being randomised. At randomisation, the intervention group received the ß-glucan supplement and continued the diet, while the control group continued with the diet only. There were follow-ups at weeks 4, 8 and 14 after randomisation. The objectives were to assess nutritional status, kidney function, plasma levels of uraemic toxins and gut microbiota using 16S rRNA sequencing at pre-randomisation. Additionally, differences in these outcomes were measured at randomisation baseline (week 0), week 8 and week 14 between the intervention and the control groups. Anthropometrical measurements were done which included weight, height, waist circumference, mid-upper arm circumference and triceps. Clinical investigations included investigating for oedema as well as gastrointestinal symptom measurement. Stool consistency was described using the Bristol Stool Score (BSS). Dietary intake was measured using a quantified food frequency questionnaire (QFFQ) and a dietary adherence score sheet. Although most of the investigations was done locally, the uraemic toxins analysis was performed at the nephrology laboratories at the University of Ghent in Belgium, while the gut microbiome analysis was performed at VIB laboratories (Leuven, Belgium). Statistical analysis was performed using IBM®SPSS®version 26/27 and R Statistical Software. Results: Seventy participants were enrolled in the study at the pre-randomisation visit. The mean age of the participants was 41.7 ± 11.8 years, with a slight predominance of females (53%). Most participants were unemployed, earning less than US$126 per month. Hypertension was the main cause of kidney failure and most participants were in stage 5 CKD. A very high prevalence of overweight (30%) and obesity (36%) was found at pre-randomisation, with a low prevalence of undernutrition (3%). Abdominal obesity was found in 60% of participants. Dietary assessment showed an unhealthy dietary pattern. After four weeks, 59 participants were randomised. The diet intervention resulted in significant nutritional changes in participants after four weeks, while uraemic toxins remained unchanged. There was a significant reduction in body mass index (P < 0.006) and waist circumference (P < 0.001). Almost all dietary intake variables were significantly reduced and there was a high dietary adherence. Serum total cholesterol (P < 0.045) and triglyceride levels (P < 0.017) were also reduced. After randomisation to either the ß-glucan prebiotic or the diet, kidney function did not significantly change. However, there was a significant reduction in uraemic toxins in free IxS at week 8 (P = 0.003) and week 14 (P < 0.001), total and free pCG (P < 0.001, P < 0.001, respectively) and free pCS (P = 0.006) at week 14. There were no significant changes in dietary intake, clinical symptoms or anthropometry during the trial. The gut microbiome revealed that two enterotypes were prevalent, namely the Bacteroides2 and Prevotella enterotypes. The inter-individual Bray–Curtis distance (ß-diversity) was significantly higher in the control group than the intervention group at baseline (P < 0.0001), week 8 (P < 0.0001) and week 14 (P = 0.02). There were no differences in relative abundance of genera between groups. The redundancy analysis showed a few factors significantly affected the gut microbiome: these included triglyceride levels (P < 0.001), cause of kidney failure (P < 0.001), gender (P < 0.001), body mass index (P = 0.002), high- density lipoprotein (P < 0.001) and the prebiotic intervention (P = 0.002). Conclusion:While four weeks of the diet resulted in some nutritional changes in participants before randomisation, it did not affect other outcomes of the study. Once randomised, the prebiotic did not significantly affect kidney function, while it significantly reduced uraemic toxins and the gut microbiome, according to the RDA analysis. The ß-glucan prebiotic therefore had some beneficial effects on outcomes in CKD participants.
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    Nutritional management of the vegan with end-stage kidney disease
    (MedPharm Publications, 2018) Esau, Nazeema; Ebrahim, Zarina
    Chronic kidney disease (CKD) is associated with nutritional complications such as anaemia, electrolyte imbalances, bone-mineral disorders, malnutrition and cardiovascular disease.1 The nutritional management in CKD is very complex since it includes multiple dietary factors e.g. the intake of protein, energy, sodium, phosphorus and potassium. Protein energy malnutrition is widely prevalent in this population, however recently obesity has also become more common. Poor dietary compliance often occurs in patients prescribed renal diets because it is known to be unpalatable and very restrictive with major lifestyle changes required.2,3 In a patient following a vegan diet, the complexity of dietary management increases due to further limitations in meeting specifically protein and micronutrient requirements. This is due to vegan diets being high in wholegrains, legumes, fruits and vegetables, which often need to be restricted in CKD.4 There are also some micronutrients that might be lacking due to avoidance of all animal products. Recent dietary pattern studies have indicated that healthy diet patterns in CKD patients reduced all-cause mortality with evidence from other studies also indicating that some of the dietary restrictions are not warranted.5,6,7 Chauveau et al8 suggested that plant-based diets should be used in clinical recommendations in the treatment and prevention of CKD. This case study explores a strictly vegan patient, admitted with end-stage kidney disease (ESKD) and his nutritional management which aimed at allowing the patient to continue veganism while trying to optimise his nutritional status.
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    Obesity and other nutrition related abnormalities in pre-dialysis chronic kidney disease (CKD) participants
    (MDPI, 2020) Ebrahim, Zarina; Moosa, M. Rafique; Blaauw, Renee
    Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.