Gut microbiota and probiotics intervention: A new therapeutic target for management of chronic kidney disease

Abstract

Epidemiological investigation showed that the prevalence of chronic kidney disease (CKD) is 8%−16%. A multi-center survey in China also showed that the total prevalence of CKD in adults is 10.8%, which demonstrated that CKD has become a global public health problem. Failed timely and effective treatment of CKD leads to progressive deterioration, and eventual development of end-stage renal disease (ESRD), which requires long-term renal replacement therapy. ESRD is accompanied by several complications and poor long-term prognosis, imposing a heavy economic burden on individuals and society. Therefore, delaying the progression of CKD and reducing the occurrence of ESRD is an urgent issue and currently is a trending research topic for nephrologists. The intestinal tract can be compared to an invisible immune organ, capable of influencing nutrition, metabolism, physiology, and immune function in the host. Intestinal homeostasis refers to the dynamic balance between the hosts mucosal barrier and intestinal microecology (including the intestinal microflora, nutritive and metabolic products, etc). The intestinal microflora is influenced by a multitude of factors such as an individuals external environment, lifestyle, eating habits, medicine intake and surgeries, etc. In recent years, gut microbiota have been considered to be involved in the occurrence and development of chronic kidney diseases (CKD). CKD is associated with impaired intestinal barrier function. Preliminary evidence indicates that toxic products generated by a dysbiotic gut microbiome and bacterial translocation may contribute to CKD progression and cardiovascular and cerebrovascular complications. The interplay between the accumulation of uremic toxins, inflammatory responses and metabolic disorders produces a vicious circle, as all three factors influence intestinal homeostasis and are crucial risk factors in the development of CKD. Therefore, it is imperative to find effective intervention measures to effectively regulate these three factors and improve intestinal homeostasis to prevent CKD progression. Probiotics, as a main intervention measure to regulate intestinal flora, may alleviate CKD progression by regulating intestinal homeostasis and reducing enteral uremic toxin. As the regulatory capacity of physiological processes by probiotics is strain specific, it is essential to choose appropriate probiotic strains according to their functional properties. Probiotics present as a new therapeutic target for management of chronic kidney disease. This review mainly summarizes the role of intestinal flora in CKD and the effect and mechanism of action of probiotics in CKD.