The Impact of CKD on Uremic Toxins and Gut Microbiota

肾脏疾病 失调 尿毒症 肠道菌群 合生元 微生物群 尿毒症毒素 炎症 生物 医学 生理学 免疫学 内分泌学 内科学 生物信息学 益生菌 细菌 遗传学
作者
Jacek Rysz,Beata Franczyk,Janusz Ławiński,Robert Olszewski,Aleksandra Ciałkowska-Rysz,Anna Gluba-Brzózka
出处
期刊:Toxins [MDPI AG]
卷期号:13 (4): 252-252 被引量:136
标识
DOI:10.3390/toxins13040252
摘要

Numerous studies have indicated that the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) is strictly associated with the accumulation of toxic metabolites in blood and other metabolic compartments. This accumulation was suggested to be related to enhanced generation of toxins from the dysbiotic microbiome accompanied by their reduced elimination by impaired kidneys. Intestinal microbiota play a key role in the accumulation of uremic toxins due to the fact that numerous uremic solutes are generated in the process of protein fermentation by colonic microbiota. Some disease states, including CKD, are associated with the presence of dysbiosis, which can be defined as an “imbalanced intestinal microbial community with quantitative and qualitative changes in the composition and metabolic activities of the gut microbiota”. The results of studies have confirmed the altered composition and functions of gut microbial community in chronic kidney disease. In the course of CKD protein-bound uremic toxins, including indoxyl sulfate, p-cresyl glucuronide, p-cresyl sulfate and indole-3-acetic acid are progressively accumulated. The presence of chronic kidney disease may be accompanied by the development of intestinal inflammation and epithelial barrier impairment leading to hastened systemic translocation of bacterial-derived uremic toxins and consequent oxidative stress injury to the kidney, cardiovascular and endocrine systems. These findings offer new therapeutic possibilities for the management of uremia, inflammation and kidney disease progression and the prevention of adverse outcomes in CKD patients. It seems that dietary interventions comprising prebiotics, probiotics, and synbiotics could pose a promising strategy in the management of uremic toxins in CKD.
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