Dietary Components That May Influence the Disturbed Gut Microbiota in Chronic Kidney Disease

Abstract

Gut microbiota imbalance is common in patients with chronic kidney disease (CKD) and associates with factors such as increased circulating levels of gut-derived uremic toxins, inflammation, and oxidative stress, which are linked to cardiovascular disease and increased morbimortality. Different nutritional strategies have been proposed to modulate gut microbiota, and could potentially be used to reduce dysbiosis in CKD. Nutrients like proteins, fibers, probiotics, and synbiotics are important determinants of the composition of gut microbiota and specific bioactive compounds such as polyphenols present in nuts, berries. and fruits, and curcumin, may also play a key role in this regard. However, so far, there are few studies on dietary components influencing the gut microbiota in CKD, and it is therefore not possible to conclude which nutrients should be prioritized in the diet of patients with CKD. In this review, we discuss some nutrients, diet patterns and bioactive compounds that may be involved in the modulation of gut microbiota in CKD and provide the background and rationale for studies exploring whether nutritional interventions with these dietary components could be used to alleviate the gut dysbiosis in patients with CKD.

Constipation in chronic kidney disease: it is time to reconsider

“…Gut dysbiosis, which refers to alterations in the composition and function of the gut microbiota, has been attracting increasing attention due to its association with various diseases, including obesity, atherosclerosis, DM, cancer, and CKD [38]. Dietary components that escape digestion in the small intestine are fermented through metabolism by the gut microbiota.…”

“…The effects of these agents on the composition of the gut microbiota and gut-derived uremic toxins have been increasingly reported. Based on a meta-analysis by McFarlane et al [79], Mafra et al did not recommend probiotics as a sole intervention, but suggested an increased intake of foods with a high content of prebiotics in CKD patients [38]. Further studies are required to establish a more effective, sophisticated prescription of these agents.…”

The Regulation of Host Intestinal Microbiota by Polyphenols in the Development and Prevention of Chronic Kidney Disease

“…The bioactive compounds in foods like polyphenols, and their potential to modulate intestinal microbiota, have been given more recent attention. These compounds, which are powerful antioxidants and natural anti-inflammatory agents, are widely used to prevent inflammation and oxidative stress in chronic "burden of lifestyle" illnesses (91). Several studies have confirmed the capacity of probiotics to control gastrointestinal disease, and the success of treating CKD patients with Clostridium difficile infection should be paid particular attention in this regard (79).…”

“…Therefore, raising similar questions about the effects of the intestinal microbiota on CKD (120) seems logical and reasonable. In comparison, the effects of food and nutraceuticals on the uremic phenotype and its contribution to intestinal dysbiosis, given the enormous capacity of food to be used as medicine for CKD, warrant much greater attention (91).…”

Novel functional food for prevention of non-communicable diseases

“…For a correction of human microbiota, it is often recommended to prescribe pro-, pre-or synbiotics. However, their use does not lead to a prevention of the NCD's due to a lack of probable criteria for assessing their efficacy in clinical trials and sporadic and non-personified use [18].…”