Chronic kidney disease and the gut microbiome

Abstract

The gut microbiome is composed of a diverse population of bacteria that have beneficial and adverse effects on human health. The microbiome has recently gained attention and is increasingly noted to play a significant role in health and a number of disease states. Increasing urea concentration during chronic kidney disease (CKD) leads to alterations in the intestinal flora that can increase production of gut-derived toxins and alter the intestinal epithelial barrier. These changes can lead to an acceleration of the process of kidney injury. A number of strategies have been proposed to interrupt this pathway of injury in CKD. The purpose of this review is to summarize the role of the gut microbiome in CKD, tools used to study this microbial population, and attempts to alter its composition for therapeutic purposes.

Keywords: chronic kidney disease; disease progression; gastrointestinal tract; indoxyl sulfate; metaproteomics; microbiome.

Fig. 1.

The gut microbiome has a variety of beneficial effects during normal human metabolism. Factors that affect the environment of the gut microbiome alter its composition. In a dysbiotic intestinal microbiota, uremic solutes affect many different tissue types. Some of these effects, such as renal tubular damage and progression of renal failure, result in further gut microbiome dysbiosis, causing a positive-feedback loop. PTH, parathyroid hormone.

Fig. 2.

A: bacteria that are decreased in abundance in patients with end-stage renal disease. B: bacteria that are increased in abundance in patients with end-stage renal disease. Taxonomic terms commonly used in gut microbiome literature are noted on the phylogenetic trees.