Alterations of Intestinal Barrier and Microbiota in Chronic Kidney Disease (CKD)
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.
Gut Microbiota and Cardiovascular Uremic Toxicities
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.
Uraemic Toxins and New Methods to Control their Accumulation: Game Changers for the Concept of Dialysis Adequacy
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.
Protein-Bound Uremic Toxins from Gut Microbiota and Inflammatory Markers in Chronic Kidney Disease
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.
The Uremic Solutes p-cresol and Indoxyl Sulfate Inhibit Endothelial Proliferation and Wound Repair
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.
As We Grow Old: Nutritional Considerations for Older Patients on Dialysis
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.
Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY): A Randomized Trial
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.
What we know about protein gut metabolites: Implications and insights for
human health and diseases
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.
The Kidney–Gut Axis: Implications for Nutrition Care
The role of the intestinal microbiota in chronic kidney disease (CKD) is gaining recognition. Our review explores how probiotics can effectively manage CKD by targeting uremic toxin production and inflammation. We propose that the interplay between uremic microbiota and impaired gut function may contribute to inflammation and complications in CKD. Probiotics offer an affordable and safe therapeutic avenue to modulate the microbiota and potentially alleviate CKD-related issues, including atherogenesis and protein energy wasting.
The Gut Microbiota and the Brain-Gut–Kidney Axis in Hypertension and Chronic Kidney Disease
Our review delves into the intricate connection between the brain, gut microbiota, and kidneys in CKD and hypertension. We propose the brain-gut-kidney axis hypothesis to explain the pathogenesis of these conditions. Understanding the role of this axis in maintaining normal balance and its dysregulation in CKD and hypertension could unveil new therapeutic targets. Exploring unique microbial communities, their metabolites, and the signals between the brain, gut, and kidneys can bridge knowledge gaps, paving the way for innovative research, clinical trials, and treatments for CKD and hypertension.
The Kidney–Gut Axis: Implications for Nutrition Care
Recent clinical evidence shows that chronic kidney disease (CKD) patients have an imbalanced gut microbiota, leading to metabolic abnormalities and health complications. Our review explores the link between dysbiotic gut microbiota and CKD progression, highlighting new therapeutic approaches through dietary interventions like protein, fiber, prebiotics, probiotics, and synbiotics. These nutritional strategies offer promising potential to revolutionize CKD dietary management.
Uremic Toxins Originating from Colonic Microbial Metabolism
Elevated levels of bacterial uremic retention molecules (URMs) in CKD are not only due to reduced renal clearance but also increased colonic generation and absorption. Strategies to reduce URMs include interventions that modulate intestinal bacterial growth (e.g., probiotics, prebiotics, dietary modification) and adsorbent therapies. Ongoing research aims to evaluate their effectiveness and clinical benefits.
p-Cresyl Sulfate Serum Concentrations in Haemodialysis Patients are Reduced by the Prebiotic Oligofructose-Enriched Inulin
Our study focused on protein-bound uraemic retention solutes, such as p-cresyl sulfate and indoxyl sulfate, which contribute to the uraemic syndrome. We investigated the effects of a prebiotic called oligofructose-enriched inulin on these solutes. Results showed that oral intake of this prebiotic was well tolerated and significantly reduced p-cresyl sulfate levels in haemodialysis patients, offering potential health benefits.
Quality of Life in Peritoneal Dialysis Patients: Decline Over Time and Association with Clinical Outcomes
Our study aimed to identify key factors impacting the quality of life (QoL) of patients with end-stage renal disease (ESRD). We observed a decline in QoL over time in patients undergoing peritoneal dialysis. By targeting specific domains that show poor QoL, tailored interventions can be planned to enhance individual patients' well-being.
The Gut Microbiome, Kidney Disease, and Targeted Interventions
The gut microbiota, comprising trillions of microbial cells, plays a crucial role in the health of individuals. Our review explores how changes in the gut microbiota of CKD patients disrupt this symbiotic relationship and contribute to disease progression. Targeted interventions, such as prebiotics and probiotics, show promise in restoring a balanced gut microbiota and potentially slowing CKD progression.
The relationship of indoxyl sulfate and p‑cresyl sulfate with target cardiovascular proteins in hemodialysis patients
Protein-bound uremic toxins (Indoxyl sulfate [IS] and p-cresyl sulfate [PCS]) are both associated with
cardiovascular (CV) and all-cause mortality in subjects with chronic kidney disease (CKD). Possible
mechanisms have not been elucidated. In hemodialysis patients, we investigated the relationship
between the free form of IS and PCS and 181 CV-related proteins. First, IS or PCS concentrations were
checked, and high levels were associated with an increased risk of acute coronary syndrome (ACS)
in 333 stable HD patients. CV proteins were further quantifed by a proximity extension assay.
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