Gut microbiome in chronic kidney disease: challenges and opportunities

Abstract

More than 100 trillion microbial cells that reside in the human gut heavily influence nutrition, metabolism and immune function of the host. Gut dysbiosis, seen commonly in patients with Chronic Kidney Disease (CKD), results from qualitative and quantitative changes in host microbiome profile and disruption of gut barrier function. Alterations in gut microbiota and a myriad of host responses have been implicated in progression of CKD, increased cardiovascular risk, uremic toxicity and inflammation. We present a discussion of dysbiosis, various uremic toxins produced from dysbiotic gut microbiome, and their roles in CKD progression and complications. We also review the gut microbiome in renal transplant, highlighting the role of commensal microbes in alteration of immune responses to transplantation, and conclude with therapeutic interventions that aim to restore intestinal dysbiosis.

Inflammation: A Key Contributor to the Genesis and Progression of Chronic Kidney Disease

“…Several recent publications have nicely detailed the contribution of intestinal dysbiosis to the genesis of uremic toxins that perpetuate a highly inflammatory Qian systemic milieu in CKD [61][62][63] . The multi-systemic detrimental effects of a uremic milieu in advanced CKD and end-stage renal disease are being discussed elsewhere in this book.…”

Non-alcoholic fatty liver disease: an emerging driving force in chronic kidney disease

“…Dysbiosis that often occurs with obesity 59 has recently been described in patients with T2DM [60][61][62][63] , NAFLD 64,65 or CKD 66,67 . For example, in NAFLD, Bacteroides species are independently associated with NASH and Ruminococcus species with significant liver fibrosis 65 .…”

“…Indole sulphate is cleared by the proximal tubules and is proinflammatory (associated with NF-B activation) and, therefore, potentially toxic to the kidneys by increasing the risk of tubule-interstitial fibrosis 67 . Other examples of molecules produced by the intestinal microbiota that are potentially toxic and excreted in the urine, are phenyl acetic acid and hippuric acid.…”

Kronik Böbrek Hastalığında Renal İnflamasyon ve Bazı Güncel Diyet Bileşenleri İlişkisi

“…Turk Neph Dial Transpl 2018; 27 (1): [14][15][16][17][18][19][20][21][22][23][24][25] Diyaliz tedavisi alan son evre böbrek yetmezliği hastalarında diyaliz sırasında kan karnitin konsantrasyonlarının düştüğü bilinmektedir. Karnitinin KBH hastalarında pozitif protein dengesine katkı sağlamasının yanı sıra anti-inflamatuvar etkilerinin olabileceği ve organ hasarına karşı koruyucu etkilerinin olduğu sınırlı da olsa bazı çalışmalarda gösterilmiştir (71)(72)(73).…”

“…Dünyada KBH'nın başlıca nedenleri arasında genetik yatkınlık, etnik köken ve artan yaş gibi değiştirilemeyen faktörlerin yanı sıra; diyabet, hipertansiyon ve glomerülonefrit gibi hastalıklar sayılmaktadır (11,14). Türkiye'de yapılan CREDIT çalışması sonuçlarına göre de hipertansiyon ve tip II diyabetes mellitus tanısı olan bireylerde KBH prevalansı daha fazla bulunmuştur (2).…”