Effect of Oral Consumption of a Symbiotic Gelatin on the Presence of Gastrointestinal Symptoms and Quality of Life in People With Chronic Kidney Disease Grades G3a, G3b, G4, G5 and G5D in Mexico

Gastrointestinal changes in CKD. In addition to the intrinsic effect of CKD on the gastrointestinal tract, extrinsic factors such as;Changes in diet (reduction in fiber consumption and increase in ultra-processed products), decrease in physical activity which impacts the reduction of gastrointestinal motility and the consumption of medications constantly can affect the structure and function at the gastrointestinal level. In HD patients without diabetes mellitus, the prevalence of dyspepsia is 40% to 70%. It is hypothesized that the pathophysiology of functional dyspepsia is multifactorial and may include a number of factors such as; abnormal gastric motility, impaired visceral sensation, dysregulation of the gut-brain axis, and low-grade inflammation.

Clinical evidence supports the theory that gut with dysbiosis contributes significantly to the deterioration of CKD progression, leading to an increase in bowel-derived uremic toxins (GDUT) and worsening of the same disease. Strategies based on interventions in the gut microbiota could contribute as preventive and therapeutic approaches to modulate the microbiota and its metabolites and thereby slow down the progression of CKD.

The origin of uremic toxins in CKD is multiple. The importance of the toxin generated by intestinal microbial metabolism is becoming more and more known. About 10 g of protein reaches the colon daily, where gut bacteria break it down into metabolites such as ammonium, amines, thiols, phenols, and indoles. These products of fermentation in the colon are eliminated in the feces, although some are absorbed and eliminated by the kidney, so they accumulate in CKD.

On the other hand, patients with CKD are constantly polymedicated. Some drugs frequently prescribed to these patients can alter the gut microbiota, especially antibiotics. There are also others that can slow down intestinal transit, phosphorus binders, ion exchange resins, or iron supplements, whose impact on the microbiota is not yet well known.

This project will provide practical information for the validation of the therapeutic effect of a symbiotic gelatin on gastrointestinal symptoms and quality of life in patients with CKD with and without replacement therapy, which will be useful both for health professionals and for the patients themselves.