The gut microbiome and the kidney

The gut microbiome outnumbers the human genome and has a symbiotic relationship with its host. An altered bacterial flora is termed dysbiosis. Gut dysbiosis is associated with the degradation of the intestinal membrane and increased intestinal permeability and translocation of gut-derived toxins into the blood. This results in inflammation, chronic kidney disease (CKD) progression, and worsening of metabolic diseases. In CKD, uremia, as well as constipation and antibiotic use, leads to further dysbiosis and accumulation of uremic toxins. Uremic toxins are associated with CKD progression, cardiovascular disease, bone disease, and inflammatory diseases. Use of prebiotics, probiotics, and synbiotics has been attempted to restore symbiosis of gut flora and has shown inconclusive results. High fiber and plant-based diets may also be beneficial to the gut microbiome, but more research is needed in patients with CKD. Targeted interventions on the gut microbiome may potentially halt the progression of kidney disease.