FiberNEW2026-10

Gut‑kidney axis in chronic kidney disease: Dysbiosis, uremic metabolites and therapeutic opportunities (Review).

Wang Yinding, Zeng Hanyu, Liu Na, Yang Dong — Molecular medicine reports

Summary

This paper explores how the balance of bacteria in our gut, known as the gut microbiome, significantly influences the progression of chronic kidney disease. When gut bacteria are out of balance, they can produce toxins that harm the kidneys, while beneficial bacteria create protective compounds. Understanding this "gut-kidney axis" offers new avenues for potential treatments, though more clinical evidence is still required.

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Key points

The health of our gut bacteria is closely linked to the progression of chronic kidney disease.
An imbalance in gut bacteria can lead to the production of toxins that accelerate kidney damage.
Beneficial gut bacteria produce protective substances that may help maintain kidney function.
Modifying the gut microbiome is a promising area for future treatments, but more research is needed.

What the study looked at

This review explored how the community of bacteria living in our gut, known as the gut microbiome, impacts the progression of chronic kidney disease (CKD). Specifically, it investigated the link between an imbalanced gut and the accumulation of harmful substances that can further damage the kidneys. This paper is a "narrative review," which means the authors meticulously gathered and analyzed existing scientific literature on the gut-kidney axis in CKD. They synthesized findings from numerous studies to provide a comprehensive overview of current knowledge, rather than conducting a new experiment with patients. The review highlighted that in CKD, there's often an unhealthy shift in gut bacteria. This imbalance leads to a reduction in beneficial bacteria that produce protective compounds, and an increase in bacteria that generate toxins. These toxins, once absorbed, contribute to inflammation and damage in the kidneys, accelerating disease progression. While strategies like probiotics or prebiotics show promise in reducing these toxins, more definitive evidence is needed to confirm their long-term benefits for kidney patients.

Dietary takeaway

To support a healthy gut and potentially benefit kidney health, consider increasing your intake of dietary fiber from a variety of plant-based foods like fruits, vegetables, whole grains, and legumes. These foods act as prebiotics, feeding beneficial gut bacteria that produce protective compounds. However, remember that this is a review summarizing existing research, and while promising, more direct clinical trials are needed to confirm specific dietary interventions for kidney disease.

Abstract

Chronic kidney disease (CKD) poses a notable global health burden. Beyond traditional pathways, the gut‑kidney axis has emerged as a potential contributor to disease progression. In the present narrative review, current evidence on the role of intestinal dysbiosis, characterized by reduced microbial diversity, depletion of beneficial short‑chain fatty acid producers and expansion of uremic toxin‑generating bacteria, in the accumulation of nephrotoxic metabolites (such as indoxyl sulfate, p‑cresyl sulfate and trimethylamine N‑oxide) is summarized. These toxins promote oxidative stress, inflammation and fibrosis, accelerating renal decline. By contrast, microbially derived short‑chain fatty acids exert protective effects. Although therapeutic strategies targeting the gut microbiome (including probiotics, prebiotics and adsorbents) and fecal microbiota transplantation (targeting the gut microbiome) exhibit potential in modulating toxin levels, evidence for clinical endpoint benefit remains insufficient. In the present review, mechanistic insights were critically evaluated, clinical intervention studies are systematically summarized in tabulated form and a roadmap for personalized, microbiota‑informed therapeutic strategies is proposed.

View on PubMed →DOI: 10.3892/mmr.2026.14047