15 May 2019

Revealing the mysterious ways the gut affects kidney disease

by Anne Crawford
Dr Matthew Snelson

Chronic Kidney Disease (CKD) is estimated to affect 13 per cent of the population globally. It is associated with a two- to three-fold increased risk of death caused by the disease itself and also carries a higher risk to patients of dying from heart disease or stroke.

Patients with CKD have increased levels of uremic toxins – toxins produced by bacteria in the gut that are normally excreted in the urine in healthy people but which build up in those with CKD.

A recent PhD graduate of Monash University’s Central Clinical School has conducted a review of literature to understand how this happens as a base to eventually finding ways of preventing it by creating new therapeutics.

Dr Matthew Snelson, a winner of the CCS’s 3MT (three minute thesis) award, became interested in CKD as a clinical dietitian working in Perth. “I was very interested in the role of gut microbiota and the mechanisms by which diet affects disease outcomes,” he said. “The emerging evidence looking at the link between the gut and the kidney was a really interesting area.”




The link had only come into focus in the past five to 10 years, he said.

Dr Snelson is particularly interested in the role and mechanisms involved in what’s called resistant starch (RS), a type of dietary fibre, in modulating the harmful gut bacteria that produce uremic toxins.

The gut is like a see-saw of ‘good’ gut bacteria and ‘bad’ ones, he said. RS promotes proliferation of ‘good’ gut bacteria such as Bifidobacteria and Lactobacilli. The studies examined in Dr Snelson’s review, using animal models and patients with CKD, showed that RS supplementation also reduced the concentrations of uremic toxins.

The narrative review, published in Advances in Nutrition, concludes that RS supplementation could be a promising dietary approach for slowing CKD progression.

R.S. is found in green (unripened) bananas, cooked and cooled potatoes, pasta and rice, and certain breeds of corn.

The specially bred corn could be added to processed foods without detracting from their flavour as had been done in a commercially available brand of white bread some time ago.

Dr Snelson said the information gathered in the review had formed the basis of animal studies he conducted investigating the mechanisms by which RS reduces uremic toxins, expected to be published soon.
Professor Melinda Coughlan

“We’d like to take the animal trials into trials with people as well to increase the evidence base regarding resistant starch in kidney disease,” he said.

While the studies in the review had focussed on the effects of RS on people with end-stage kidney disease – patients on kidney dialysis to remove the toxins – Dr Snelson wants to test this on different groups of people with the disease.

“No one has looked at RS supplementation in early kidney disease patients. It could be a good way to complement existing therapies,” he said. “I think it’s got good potential in terms of acceptance by patients.”


Dr Snelson is continuing his work as a post-doctoral researcher working in last author Associate Professor Melinda Coughlan’s lab in the Department of Diabetes.

To read more about this research:
Snelson M, Kellow NJ, Coughlan MT. Modulation of the Gut Microbiota by Resistant Starch as a Treatment of Chronic Kidney Diseases: Evidence of Efficacy and Mechanistic Insights. Advances in Nutrition, 2019. 10(2): p. 303-320.

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