Gut Microbiome in Chronic Kidney Disease

Abstract

With over 100 trillion microbial cells, the gut microbiome plays important roles in both the maintenance of health and the pathogenesis of disease. Gut microbiome dysbiosis, resulted from alteration of composition and function of the gut microbiome and disruption of gut barrier function, is commonly seen in patients with chronic kidney disease (CKD). The dysbiotic gut microbiome generates excessive amounts of uremic toxins, and the impaired intestinal barrier permits translocation of these toxins into the systemic circulation. Many of these uremic toxins have been implicated in the progression of CKD and increased cardiovascular risk. Various therapeutic interventions have been proposed that aim to restore gut microbiome symbiosis. If proven effective, these interventions will have a significant impact on the management of CKD patients. In this review, we discuss the consequences of gut microbiome dysbiosis in the context of CKD, discuss the consequences of gut dysbiosis, and highlight some of the recent interventions targeting the gut microbiome for therapeutic purposes.

Gut-derived uremic toxin handling in vivo requires OAT-mediated tubular secretion in chronic kidney disease

“…Comparison to colon-derived endogenous metabolites. It is increasingly appreciated that many uremic solutes are derived from the colon, either through the action of colonic microbes or from colon cell metabolism (46). In the metabolomics analyses performed here, presumptive colon-derived uremic toxins were identified on the metabolomics platform (47-62) ( Table 1).…”

Dietary Changes Involving <b><i>Bifidobacterium</i></b> <b><i>longum</i></b> and Other Nutrients Delays Chronic Kidney Disease Progression

“…The gut microbiota plays a role in human health. Dysbiosis (disturbance of normal gut microbiota) is reported to be associated with CKD [4] because patients with CKD are exposed to uremic toxins and malnutrition, such as insufficient dietary fiber. The gut microbiota was associated with the metabolism of uremic toxins, and uremic toxins such as indoxyl sulfate and p-cresol sulfate were derived from it [5].…”

Gut microbiota generation of protein-bound uremic toxins and related metabolites is not altered at different stages of chronic kidney disease

“…Based on the altered microbial community composition and function, and the elevated plasma uremic toxin levels in CKD, it has been hypothesized that the generation of uremic toxin precursors could change with CKD progression. 43,44 However, to our knowledge, no comprehensive data are available about the uremic toxin precursor levels in the gut environment of CKD patients, or about the toxin-generating capacity of gut microbiota. Therefore, this study was designed to determine fecal levels of PBUTs and their precursors, in parallel to plasma and urinary concentrations of PBUTs in different stages of CKD.…”