[Uremic toxins and gut micro biome].

Area of Science:

• Microbiology
• Nephrology
• Gastroenterology

Background:

• Systemic inflammation is a key driver of chronic kidney disease (CKD) progression and its complications.
• The gut microbiome plays a crucial role in host health, influencing metabolism and immunity.
• The intestine's role as a source of systemic inflammation in CKD has been historically underestimated.

Purpose of the Study:

• To review the impact of CKD on gut microbiome composition and function.
• To explore the mechanisms by which CKD-induced gut dysbiosis contributes to systemic inflammation and uremic toxicity.
• To discuss potential interventions for mitigating gut abnormalities in CKD patients.

Main Methods:

• Literature review of studies investigating the gut microbiome in CKD.
• Analysis of biochemical and physiological changes in the CKD gastrointestinal environment.
• Examination of microbial-derived toxins and their systemic effects.

Main Results:

• CKD alters the gut microbiome due to urea/uric acid influx, dietary restrictions, and medications.
• Microbial dysbiosis in CKD generates uremic toxins (e.g., indoxyl sulfate, p-cresol sulfate) and reduces beneficial short-chain fatty acids (SCFAs).
• CKD disrupts the intestinal epithelial barrier, increasing translocation of endotoxins and inflammatory mediators.

Conclusions:

• CKD significantly impacts the gut microbiome and intestinal barrier integrity.
• Gut dysbiosis and barrier dysfunction in CKD promote systemic inflammation, uremic toxicity, and oxidative stress.
• Targeting the gut microbiome and restoring intestinal barrier function presents a promising therapeutic avenue for CKD management.