Gut microbiota and chronic kidney disease: evidences and mechanisms that mediate a new communication in the gastrointestinal-renal axis

RUKAVINA MIKUSIC, NATALIA LUCÍA; KOUYOUMDZIAN, NICOLÁS MARTÍN; CHOI, MARCELO ROBERTO

PFLUGERS ARCHIV-EUROPEAN JOURNAL OF PHYSIOLOGY

SPRINGER

Año: 2020 vol. 472 p. 303 - 320

0031-6768

Chronic kidneydisease (CKD) represents a growing public health problem associated with loss of kidney function and cardiovascular disease(CVD), the main leading cause of morbidity and mortality in CKD. It is well established that CKD isassociated with gut dysbiosis. Over the past few years, there has been agrowing interest in studying the composition of the gut microbiota in patientswith CKD as well as the mechanisms by which gut dysbiosis contributes to CKD progression,in order to identify possible therapeutic targets to improve the morbidity andsurvival in CKD. The purpose of thisreview is to explore the clinical evidence and the mechanisms involved in the gut-kidneycrosstalk as well as the possible interventions to restore a normal balance ofthe gut microbiota in CKD. It is well known that the influenceof the gut microbiota on the gut?kidney axis acts in a reciprocal way: on onehand, CKD significantly modifies the composition and functions of the gutmicrobiota. On the other hand, gut microbiota is able to manipulate theprocesses leading to CKD onset and progression through inflammatory, endocrine,and neurologic pathways. Understanding the complexinteraction between these two organs (gut microbiota and kidney) may providenovel nephroprotective interventions to prevent the progression of CKD bytargeting the gut microbiota. The review is divided into threemain sections: evidences from clinical studies about the existence of a gutmicrobiota dysbiosis in CKD; the complex mechanisms that explains thebidirectional relationship between CKD and gut dysbiosis; and reports regardingthe effects of prebiotic, probiotic and synbiotic supplementation to restoregut microbiota balance in CKD.