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Phytosomal Curcumin Supplementation May Benefit Patients with Mild Chronic Kidney Disease

Date 03-31-2022
HC# 022251-685
Turmeric (Curcuma longa, Zingiberaceae)
Chronic Kidney Disease

Pivari F, Mingione A, Piazzini G, et al. Curcumin supplementation (Meriva®) modulates inflammation, lipid peroxidation and gut microbiota composition in chronic kidney disease. Nutrients. January 5, 2022;14(1):231. doi:10.3390/nu14010231.

Chronic kidney disease (CKD) affects more than 13% of the world's population and is caused by progressive loss of renal function. Gut microbiota modulates inflammation and changes over the course of CKD. It is suggested that interventions for gut microbiota can help mitigate the effects of CKD. Curcumin, the active constituent of turmeric (Curcuma longa, Zingiberaceae) root, is known for its anti-inflammatory properties. Studies have indicated that it can increase the expression of intestinal alkaline phosphatase and tight junction proteins, improving gut permeability and inflammation. Curcumin is poorly absorbed through oral consumption; however, phytosomal delivery systems using lecithin phospholipids have been developed to increase absorption. The authors conducted a pilot study to observe the potential benefits of a proprietary curcumin-phospholipid supplement for patients with mild CKD.

The study took place between February 2018 and February 2019 at the Nephrology and Dialysis Unit of the Azienda Socio-Sanitaria Santi Paolo and Carlo in Milan, Italy. Eligible patients were aged ≥ 18 years with stage 3a to 4 CKD, not on hemodialysis, had no chronic infections, active neoplasm, vasculitis, autoimmune or acute inflammatory diseases, gastro-intestinal pathologies, dementia, steroid therapies, and were not pregnant. Control group inclusion criteria included all the above except participants did not have CKD. The control group was enrolled through the Ophthalmology Unit at the same institute; they did not undergo the trial, but were used as a baseline for anthropometric, nutritional, and microbiome analyses.

Participants received Meriva® (INDENA S.p.A.; Milan, Italy) 500 mg/tablets that contained 100 mg of bioavailable curcuminoids. Patients were to take one tablet twice a day for three or six months. At baseline (T0), three months (T1), and six months (T2), the patient's clinical parameters, anthropometric and body composition measures, dietary habits, and stool and blood samples were collected. Clinical parameters included serum creatinine, blood urea nitrogen, sodium, potassium, calcium, phosphorous, and glomerular filtration rate (GFR). Anthropometric and body composition measures included weight, height, waist circumference, body mass index (BMI), total body water, extracellular water, intracellular water, fat-free mass, and fat mass. Blood analysis included cytokines, chemokines, lipids, and uremic toxins; gut microbiota sequencing was performed using stool specimens. Patients recorded a three-day food diary to estimate general food consumption.

A total of 24 patients with CKD enrolled in the study; 58% were male-identifying with a mean age of 71 ± 12 years. The control included 20 participants; 50% male-identifying with a mean age of 73 ± 8 years. Of the 24 patients, 21 completed three months of the study, and 11 completed all six months. Reasons for withdrawal were not related to study product, and no adverse effects were reported. There were no significant differences between groups for gender distribution, age, BMI, and waist circumference at T0. At T1, there was a significant reduction of fat mass for the CKD group compared to control (P < 0.0001); however, there was only an increasing trend for fat-free mass percentage. There were no other differences in anthropomorphic parameters at T2.

There was a significant reduction of monocyte chemoattractant protein 1 at T1 compared to baseline (P < 0.01); however, the reduction was not confirmed at T2. Interleukin 4 (P < 0.01) and interferon-γ (P < 0.05) were significantly reduced at T2 compared to baseline. There were no significant differences for the remaining cytokines and chemokines. There was a significant reduction in thiobarbituric acid reactive substances levels at T1 (P < 0.001) and T2 (P < 0.0001) compared to baseline. There was no significant decrease in uremic toxins.

The CKD group had a higher alpha-diversity values compared to control (P < 0.01) at baseline. There was a significant decrease in alpha-diversity values at T2 (P < 0.04). For beta-diversity, there was a significant difference at baseline for the CKD group compared to control (P = 0.023). There was a shift toward lower diversity by the end of study for beta-diversity in the CKD group. At baseline, there was a significantly lower number of Bacteroides (P = 0.037), Lachnoclostridium (P = 0.018), and Escherichia-Shigella (P = 0.048) in the CKD group compared to control. After intervention, there was a decrease in Verrucomicrobia (P = 0.016) and Enterobacteriaceae (P = 0.047) in the CKD group compared to control. There was a significant increase in Lachnoclostridium in the CKD group (P < 0.001). Compared to baseline, there was a reduction in the CKD group at T1 (P = 0.048) for Firmicutes. There was a significant increase at T2 compared to T1 for Lactobacillaceae (P = 0.033) and an increasing trend for Prevotellaceae. There was also a significant increase for Lachnospira at T2 compared to baseline in the CKD group (P = 0.030).

The authors conclude that phytosomal curcumin reduces plasma pro-inflammatory mediators and lipid peroxidation. Although it did not improve uremic toxins, it did keep the toxins stable. There was also a significant trend toward healthy gut microbiota values. Limitations include using a small sample size and having a high drop-out rate. This pilot study encourages placebo-controlled trials to be performed to help verify results. The authors state that two of the authors are employees of INDENA S.p.A.

Dani Hoots