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Intestinal Barrier Dysfunction in Chronic Kidney Disease: Evidence, Mechanisms, and its Potential Clinical
Ward Zadora1,2, Elisabeth Jacobs1, Mara Lauriola1,2
1Nephrology and Renal Transplantation Research Group Department of Microbiology, Immunology and Transplantation, KULeuven, Leuven, Belgium.
Summary
Intestinal barrier dysfunction is evident in chronic kidney disease (CKD), especially in advanced stages. More standardized research is needed to confirm findings and explore gut permeability interventions for CKD.
Area of Science:
- Nephrology
- Gastroenterology
- Microbiome Research
Background:
- The gut-kidney axis is crucial in chronic kidney disease (CKD), with intestinal barrier dysfunction potentially driving inflammation and toxin buildup.
- Existing research on gut permeability in CKD is inconsistent due to varied study designs and outcome measures.
Purpose of the Study:
- To systematically review and synthesize experimental and clinical evidence on gut permeability in CKD.
- To identify knowledge gaps and inconsistencies in the current understanding of the gut-kidney axis in CKD.
Main Methods:
- A comprehensive search of major databases (Embase, PubMed, Web of Science, Cochrane Library, Scopus) was conducted.
- Included studies investigated intestinal barrier function in CKD patients or models with a control group.
- Data on permeability markers, tight junction proteins (TJPs), and related outcomes were extracted, and risk of bias was assessed.
Main Results:
- 143 studies were included, comprising in vitro, animal, and human research.
- In vitro and animal models showed increased gut permeability and altered tight junction protein expression.
- Human studies indicated elevated permeability biomarkers in advanced CKD and dialysis, with preliminary associations to inflammation and sarcopenia.
Conclusions:
- Evidence supports impaired intestinal barrier function in advanced CKD, but heterogeneity and bias limit definitive conclusions.
- Standardized methodologies and longitudinal clinical studies are essential for clarifying the role of gut permeability in CKD progression.
- Further research is needed to evaluate the potential of barrier-targeted interventions in improving CKD outcomes.
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