Dietary Components That May Influence the Disturbed Gut Microbiota in Chronic Kidney Disease.

Denise Mafra,Bengt Lindholm,Marta Esgalhado,Peter Stenvinkel,Natália Borges,Ludmila Cardozo,Livia Alvarenga

doi:10.3390/nu11030496

Abstract

Gut microbiota imbalance is common in patients with chronic kidney disease (CKD) and associates with factors such as increased circulating levels of gut-derived uremic toxins, inflammation, and oxidative stress, which are linked to cardiovascular disease and increased morbimortality. Different nutritional strategies have been proposed to modulate gut microbiota, and could potentially be used to reduce dysbiosis in CKD. Nutrients like proteins, fibers, probiotics, and synbiotics are important determinants of the composition of gut microbiota and specific bioactive compounds such as polyphenols present in nuts, berries. and fruits, and curcumin, may also play a key role in this regard. However, so far, there are few studies on dietary components influencing the gut microbiota in CKD, and it is therefore not possible to conclude which nutrients should be prioritized in the diet of patients with CKD. In this review, we discuss some nutrients, diet patterns and bioactive compounds that may be involved in the modulation of gut microbiota in CKD and provide the background and rationale for studies exploring whether nutritional interventions with these dietary components could be used to alleviate the gut dysbiosis in patients with CKD.

Highlights

The human gut ecosystem is very complex, supporting a diverse and dynamic bacterial community, which is of paramount importance to the hosts health because gut microbiota has no simple commensal relationship with humans, but rather takes part in a mutualistic symbiotic cooperation offering benefits for all involved [1]
The presence of dysbiosis favors the growth of bacteria that possess enzymes capable of generating uremic toxins such as indoxyl sulfate (IS), p-cresyl sulfate (p-CS), indole-3-acetic acid (IAA), and trimethylamine-N-oxide (TMAO), which accumulate in chronic kidney disease (CKD) [6]
We reviewed studies that investigated how different dietary components may impact gut microbiota, its metabolites, and how this could influence the uremic phenotype in a positive way (Figure 1)

Summary

Introduction

The human gut ecosystem is very complex, supporting a diverse and dynamic bacterial community, which is of paramount importance to the hosts health because gut microbiota has no simple commensal relationship with humans, but rather takes part in a mutualistic symbiotic cooperation offering benefits for all involved [1]. In advanced CKD, uremia alters the biochemical milieu, promoting disturbances in gut microbiota and the intestinal barrier [4,5]. Nutrients 2019, 11, 496 restrictions of fruits and vegetables required for preventing hyperkalemia), and multi-drug regimens alter the biochemical environment in the uremic intestines contributing to dysbiosis [5]. Dysbiosis causes the breakdown of epithelial tight junctions, leading to translocation of lipopolysaccharides (LPS), immune dysregulation, and inflammation [7]. These alterations in the uremic milieu associate with severe consequences such as further progression of CKD towards end stage renal disease, complications such as protein energy wasting, and CVD, leading to increased mortality [8,9]

Objectives

Results

Conclusion