Microbiome and Cardiovascular Disease in CKD

Area of Science:

• Microbiology
• Nephrology
• Cardiology

Background:

• Patients with chronic kidney disease (CKD) experience significantly higher rates of cardiovascular mortality compared to the general population.
• Unique, non-traditional risk factors associated with declining kidney function are increasingly implicated in this disparity.
• Alterations in the intestinal microbiome, known as intestinal dysbiosis, are emerging as a critical factor in CKD pathophysiology.

Purpose of the Study:

• To review the role of the gut microbiome in promoting cardiovascular disease (CVD) in CKD patients.
• To explore how intestinal dysbiosis and associated mechanisms contribute to atherosclerosis and adverse cardiovascular outcomes.
• To discuss potential interventions targeting the microbiome for CVD prevention in CKD.

Main Methods:

• This is a narrative review synthesizing current scientific literature.
• Focuses on microbiome-mediated pathways linking CKD to CVD.
• Includes analysis of new data on intestinal barrier dysfunction, bacterial translocation, and endotoxemia.

Main Results:

• CKD is associated with intestinal dysbiosis, altering gut micro-organism composition and function.
• Dysbiosis byproducts are linked to vascular calcification, atherosclerosis, and poor cardiovascular outcomes in CKD.
• Defective intestinal barrier function in CKD may exacerbate the impact of pathogenic bacteria, increasing systemic inflammation.

Conclusions:

• Intestinal dysbiosis, impaired gut barrier function, and reduced kidney clearance of bacterial products collectively promote CVD in CKD.
• Bacterial translocation and endotoxemia resulting from barrier dysfunction drive systemic inflammation.
• Accumulation of dietary-derived bacterial byproducts stimulates atheromatous changes in arteries, contributing to CVD.