Therapeutic potential and research progress of microecological agents in kidney diseases

Patients with kidney disease often exhibit pathological alterations such as gut dysbiosis, accumulation of uremic toxins, and systemic inflammation. In recent years, microecological agents-represented by pre-biotics, probiotics, and synbiotics-have emerged as a novel strategy targeting the "gut-kidney axis." These agents act through mechanisms including modulation of gut microbiota balance, improvement of intestinal barrier function, reduction of endotoxin levels, and anti-inflammatory as well as antioxidant effects. Our review of the available evidence on microecological agents across various kidney diseases reveals that these interventions can delay the progression of renal function decline in patients with Chronic Kidney Disease (CKD) by restoring gut microbiota balance and reducing the systemic burden of uremic toxins and other harmful metabolites. Concurrently, they help mitigate CKD-related complications, including mineral and bone disorders, cardiovascular and cerebrovascular events, and hyperuricemia. Moreover, microecological agents have demonstrated beneficial effects in attenuating renal injury in acute kidney injury (AKI), reducing the incidence of nephrolithiasis, and exerting a modulatory role in lupus nephritis (LN). However, existing evidence remains unevenly distributed, and conclusions regarding efficacy vary due to differences in the type, dosage, and timing of microecological interventions, thus necessitating a systematic review. This article synthesizes current research on microecological agents across various kidney diseases, systematically evaluates their clinical efficacy and heterogeneity, and discusses future development strategies and translational potential.