Abstract
BackgroundChronic kidney disease (CKD) is a universal chronic disease in China. The balance of the gut microbiome is highly crucial for a healthy human body, especially for the immune system. However, the relationship between the gut microbiome and CKD has not yet been clarified.MethodsA total of 122 patients were recruited for this study. Among them, 24 patients were diagnosed with CKD5 but did not receive hemodialysis therapy, 29 patients were diagnosed with CKD5 and received hemodialysis therapy and 69 were matched healthy controls. The gut microbiome composition was analyzed by a 16S rRNA (16S ribosomal RNA) gene-based sequencing protocol. High-performance liquid chromatography–electrospray ionization-tandem mass spectrometry (HPLC/ESI-MS/MS) technology was used to evaluate the levels of microbiome-related protein-binding uremic toxins level, indoxyl sulfate (IS) and p-cresyl sulfate (PCS), in the patients.ResultsWe compared the gut microbiome results of 122 subjects and established a correlation between the gut microbiome and IS and PCS levels. The results indicated that alpha and beta diversity were different in patients with CKD5 than in the healthy controls (p < 0.01). In comparison to healthy controls, CKD5 patients exhibited a significantly higher relative abundance of Neisseria (p < 0.001), Lachnoclostridium (p < 0.001) and Bifidobacterium (p < 0.001). Faecalibacterium (p < 0.001) displayed a notably lower relative abundance for CKD5 patients both with and without hemodialysis than for controls. It was also found that the concentrations of IS and PCS were correlated with the gut microbiome.ConclusionsOur results indicate that CKD5 patients both with and without hemodialysis had dysbiosis of the gut microbiome and that this dysbiosis was associated with an accumulation of IS and PCS. These results may support further clinical diagnosis to a great extent and help in developing potential probiotics to facilitate the treatment of CKD5.
Highlights
Chronic kidney disease (CKD) is a universal chronic disease in China
These substances have been proven to promote renal fibrosis, the risk of cardiovascular disease, insulin resistance and chronic kidney disease mineral and bone disorder (CKDMBD) [8,9,10], and they could be influenced by the composition of the gut microbiome [11]
Study subjects Following approval by the Medical Ethics Committee of Shandong Provincial Qianfoshan Hospital (2017-S015), we registered on the Chinese Clinical Trial Registry (ChiCTR1800015221) and recruited 122 individuals at Shandong Provincial Qianfoshan Hospital based on the diagnostic criteria for CKD in adults outlined in the KDIGO [14]
Summary
Chronic kidney disease (CKD) is a universal chronic disease in China. The balance of the gut microbiome is highly crucial for a healthy human body, especially for the immune system. In patients with stage 5 chronic kidney disease, there are many harmful substances known as uremic toxins, which are one of the main causes of cardiovascular complications. It is well known that protein-binding uremic toxin production increases in patients with CKD5, of which the most representative examples are IS and PCS. These substances have been proven to promote renal fibrosis, the risk of cardiovascular disease, insulin resistance and chronic kidney disease mineral and bone disorder (CKDMBD) [8,9,10], and they could be influenced by the composition of the gut microbiome [11]. Some studies of changes in the gut microbiome in CKD patients have been reported [13], but the exact relationship between the gut microbiome and CKD5, especially in Chinese people, has not been validated clearly
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