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The Impact of CKD on Uremic Toxins and Gut Microbiota.
Toxins (Basel). 2021 Mar 31; 13(4)T

Abstract

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.

Authors+Show Affiliations

Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland.Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland.Department of Urology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszow, Poland.Department of Gerontology, Public Health and Didactics, Rheumatology and Rehabilitation, National Institute of Geriatrics, 02-637 Warsaw, Poland. Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-637 Warsaw, Poland.Palliative Medicine Unit, Department of Oncology, Medical University of Lodz, 90-549 Lodz, Poland.Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33807343

Citation

Rysz, Jacek, et al. "The Impact of CKD On Uremic Toxins and Gut Microbiota." Toxins, vol. 13, no. 4, 2021.
Rysz J, Franczyk B, Ławiński J, et al. The Impact of CKD on Uremic Toxins and Gut Microbiota. Toxins (Basel). 2021;13(4).
Rysz, J., Franczyk, B., Ławiński, J., Olszewski, R., Ciałkowska-Rysz, A., & Gluba-Brzózka, A. (2021). The Impact of CKD on Uremic Toxins and Gut Microbiota. Toxins, 13(4). https://doi.org/10.3390/toxins13040252
Rysz J, et al. The Impact of CKD On Uremic Toxins and Gut Microbiota. Toxins (Basel). 2021 Mar 31;13(4) PubMed PMID: 33807343.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Impact of CKD on Uremic Toxins and Gut Microbiota. AU - Rysz,Jacek, AU - Franczyk,Beata, AU - Ławiński,Janusz, AU - Olszewski,Robert, AU - Ciałkowska-Rysz,Aleksanda, AU - Gluba-Brzózka,Anna, Y1 - 2021/03/31/ PY - 2021/2/5/received PY - 2021/3/23/revised PY - 2021/3/28/accepted PY - 2021/4/3/entrez PY - 2021/4/4/pubmed PY - 2021/6/30/medline KW - cardiovascular risk KW - chronic kidney disease KW - gut microbiota KW - uremic toxins JF - Toxins JO - Toxins (Basel) VL - 13 IS - 4 N2 - 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. SN - 2072-6651 UR - https://www.unboundmedicine.com/medline/citation/33807343/The_Impact_of_CKD_on_Uremic_Toxins_and_Gut_Microbiota_ DB - PRIME DP - Unbound Medicine ER -