ArticleThe American journal of clinical nutrition2022
The association between TMAO, CMPF, and clinical outcomes in advanced chronic kidney disease: results from the European QUALity (EQUAL) Study.
Article in The American journal of clinical nutrition, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
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Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- The microbiome-derived metabolite trimethylamine N-oxide is associated with chronic kidney disease risk.Applied microbiology and biotechnology · 2025Pooled it
- Causal relationship between blood metabolites and risk of five infections: a Mendelian randomization study.BMC infectious diseases · 2023Pooled it
- Cardiovascular-kidney-metabolic syndrome through the lens of gut‑derived uremic toxins.Gut microbes · 2026Review
- Trimethylamine N-oxide and major adverse cardiac and cerebrovascular events: results of umbrella review and meta-analysis.Nutrition & metabolism · 2026Article
- Review
- Review
- TMAO Induced Kidney Aging by Activating ZBP1-Mediated Necroptosis.Physiological research · 2026Article
- Kidney Disease as a Driver of Immunosenescence: Mechanisms and Potential Interventions.Journal of the American Society of Nephrology : JASN · 2026Review
- Correlations Between Trimethylamine-N-Oxide, Megalin, Lysine and Markers of Tubular Damage in Chronic Kidney Disease.Toxins · 2025Article
- Utility of trimethylamine N-oxide (TMAO) as a biomarker for risk stratification in chronic kidney disease: a multicenter observational study.BMC nephrology · 2025Observational
- Review
- A scoping review on the possible immunometabolic properties of the furan fatty acid metabolite 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid.The American journal of clinical nutrition · 2025Article
- Gut Microbiota Metabolites and the Development of CKD.Clinical journal of the American Society of Nephrology : CJASN · 2025Article
- Effects of Long-Term Airport Noise Exposure on Inflammation and Intestinal Flora and Their Metabolites in Mice.Metabolites · 2025Article
- Metabolomics to Identify Unclassified Uremic Toxins: A Comprehensive Literature Review.Kidney medicine · 2025Review
- The microbial metabolite trimethylamine N-oxide and the kidney diseases.Frontiers in cellular and infection microbiology · 2025Review
- The safety of a low-protein diet in older adults with advanced chronic kidney disease.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Observational
- Metabolomics signatures of sweetened beverages and added sugar are related to anthropometric measures of adiposity in young individuals: results from a cohort study.The American journal of clinical nutrition · 2024Article
- Pathological mechanisms of kidney disease in ageing.Nature reviews. Nephrology · 2024Review
- TMAO is involved in kidney-yang deficiency syndrome diarrhea by mediating the "gut-kidney axis".Heliyon · 2024Article
Corrections and comments
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Authors and funding
18 authors at 8 institutions in 8 countries.
Funding
Abstract
backgroundTrimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source.
objectivesWe hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes.
methodsPatients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged ≥65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to ≤20 mL/min per 1.73 m2 during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake.
resultsDuring a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models.
conclusionsHigh CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified.
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Registered trials
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