In CKD, the kidney-gut axis plays a crucial role. Our review delves into the intimate connection between the intestinal barrier, gut microbiota, inflammation, and uraemic toxicity in CKD. We discovered that CKD patients experience chronic inflammation due to bacterial translocation and accumulation of uraemic toxins. By modulating the gut microbiota with probiotics or prebiotics, we can potentially reduce uraemic solute production and alleviate chronic inflammation, offering hope for improved cardiovascular health in CKD patients.

Cardiovascular disease (CVD) poses a significant threat to individuals with chronic kidney disease (CKD). Our comprehensive review examined the link between uremic toxins and the heightened risk of CVD in CKD. We highlight emerging evidence on the role of gut microbiota in uremic toxin production and CKD-CVD development. The review explores the detrimental effects of uremic toxins on the heart and blood vessels and discusses potential therapeutic interventions, including dietary adjustments, prebiotics/probiotics, oral sorbents, and innovative dialysis techniques targeting protein-bound uremic toxins.

Our review challenges the limited notion of dialysis adequacy solely based on the dialysis process. Recognizing the significance of uraemic toxicity and advancements in limiting toxin accumulation, we propose a broader concept of adequacy. This involves various approaches like preserving renal function, dietary modifications, reducing toxin generation and absorption, ultrafiltration, and adsorption techniques. A comprehensive evaluation of key uraemic toxins could serve as a better indicator of treatment quality, with a focus on controlling toxicity while prioritizing patient well-being.

Our study highlights the role of uremic toxins in contributing to chronic inflammation and cardiovascular complications in chronic kidney disease (CKD) patients. Uremic toxins such as IS, p-CS, and IAA are implicated in the development of inflammation. By implementing strategies to reduce uremic toxin generation, we can potentially mitigate inflammation and prevent cardiovascular diseases in CKD patients.

Our study examined the link between uremic retention solutes and endothelial dysfunction, a key factor in cardiovascular diseases affecting uremic patients. Through in vitro testing, we found that solutes like p-cresol and indoxyl sulfate hindered endothelial proliferation and wound repair. These findings suggest their potential contribution to endothelial dysfunction in uremic patients.

Our review addresses the nutritional challenges faced by older patients on dialysis and explores the importance of tailored renal nutrition guidelines. We highlight potential interventions to meet their unique nutritional needs. To enhance their quality of life and outcomes, we emphasize the significance of collaborative efforts between renal and geriatric healthcare professionals.

Dysbiotic gut microbiota in CKD contributes to the generation of uremic toxins, indoxyl sulfate (IS), and p-cresyl sulfate (PCS). Our study investigated the impact of synbiotic therapy on the gut microbiota and serum concentrations of these toxins in CKD patients. The findings showed that synbiotic therapy effectively reduced PCS and, to a lesser extent, IS levels, especially in patients without antibiotic treatment.

Gut microbiota is a complex ecosystem of symbiotic bacteria that contribute to human metabolism and supply
intestinal metabolites, whose production is mainly influenced by the diet. Dietary patterns characterized by a
high intake of protein promotes the growth of proteolytic bacteria’s, which produce metabolites from undigested
protein fermentation. Microbioal protein metabolites can regulate immune, metabolic and neuronal responses in
different target organs.