Gut Microbiota In Chronic Kidney Disease

Abstract

In health, the relationship between gut microflora and the host is of a mutualistic kind. Microbiota offers many benefits to the host, including harvesting energy, regulating host immunity, and the synthesis of vitamins. Alteration in gut microflora can lead to homeostasis disruption and development of various diseases. Dysbiosis is commonly observed in chronic kidney disease (CKD). Nutrient processing by gut microbiota results in the production of some uremic toxins, and these accumulate in CKD causing deleterious effects. Increased permeability of the intestinal barrier, which is also seen in CKD contributes to the development of the uremic state. These factors are associated with chronic inflammation and oxidative stress and therefore are involved in CKD-related complications, including disease progression, cardiovascular disease, anemia, mineral-metabolism, and insulin resistance. This review describes connections between altered gut microflora and development of CKD and its complications, as well as possible therapeutic options. 1. Mikrobiota-krótka charakterystyka. 2. Mechanizmy doprowadzające do jakościowych i ilościowych zmian mikrobioty jelit w prze wlekłej chorobie nerek i ich wpływ na strukturę bariery jelitowej. 3. Przyczyny progresji przewlekłej choroby nerek związane z zaburzeniem mikrobioty jelitowej. 4. Powikłania przewlekłej choroby nerek związane ze zmianą mikrobioty jelitowej. 4.1. Choroby sercowo-naczyniowe. 4.2. Anemia. 4.3. Zaburzenia metabolizmu kostnego. 4.4. Insulinooporność w przewlekłej chorobie nerek. 5. Możliwości terapeutyczne. 6. Podsumowanie

Focus on the Gut–Kidney Axis in Health and Disease

“…Authors reported ( 77 ) decrease in the anaerobic microflora in patients with CKD, while an increase of the aerobic microflora background ( 78 ) is observed with a predominance of Enterobacteriaceae ( 79 ). As previously discussed gut microbiota in healthy recipients possess three main enterotypes ( 80 ): Bacteroides, Prevotella , or Ruminococcus .…”

“…As previously discussed gut microbiota in healthy recipients possess three main enterotypes ( 80 ): Bacteroides, Prevotella , or Ruminococcus . As previously stated, the gut microbiota in patients with CKD is shifted, characterized by low numbers of Lactobacillaceae and Prevotellaceae families and higher Enterobacteria and Enterococci ( 79 ).…”

“…CKD and ESRD influence considerably the composition of the intestinal flora and by extension its functions due to the multifaced occurring processes: impact of uremia, inflammation, and diet ( 79 ). However, it is noteworthy that dysbiosis in CKD patients may enhance uremic toxin concentrations that in their turn are involved in the progression of CKD ( 79 ). In developing countries, CKD is related to hypertension, diabetes, obesity, cardiovascular disease, glomerular and tubule interstitial, and aging ( 68 ).…”

“…Dialysis permits elimination of a large number of toxins and waste solutes involved in the uremic syndrome. Of note is that hemodialysis or peritoneal dialysis may augment the permeability of the intestinal barrier in CKD patients and thus contributing to the translocation of endotoxins ( 79 ).…”

“…The gut microbiome of ESRD adult patients ( Table 1 ) who underwent hemodialysis showed rise in Proteobacteria, Actinobacteria , and Firmicutes with preponderance of the subphylum Clostridia ( 79 ). Differences were observed in pediatric patients who underwent hemodialysis, as an increase in Bacteroidetes was found and reduction in Proteobacteria taxa ( 80 ).…”