The gut–kidney axis
Abstract
The host-gut microbiota interaction has been the focus of increasing interest in recent years. It has been determined that this complex interaction is not only essential to many aspects of normal "mammalian" physiology but that it may also contribute to a multitude of ailments, from the obvious case of inflammatory bowel disease to (complex) diseases residing in organs outside the gut. An increasing body of evidence indicates that crosstalk between host and microbiota is pathophysiologically relevant in patients with chronic kidney disease (CKD). Interactions are bidirectional; on the one hand, uremia affects both the composition and metabolism of the gut microbiota and, on the other hand, important uremic toxins originate from microbial metabolism. In addition, gut dysbiosis may induce a disruption of the epithelial barrier, ultimately resulting in increased exposure of the host to endotoxins. Due to dietary restrictions and gastrointestinal dysfunctions, microbial metabolism shifts to a predominantly proteolytic fermentation pattern in CKD. Indoxyl sulfate and p-cresyl sulfate, both end-products of protein fermentation, and trimethylamine-N-oxide, an end-product of microbial choline and carnitine metabolism, are prototypes of uremic toxins originating from microbial metabolism. The vascular and renal toxicity of these co-metabolites has been demonstrated extensively in experimental and clinical studies. These co-metabolites are an appealing target for adjuvant therapy in CKD. Treatment options include dietary therapy, prebiotics, probiotics and host and bacterial enzyme inhibitors. Final proof of the concept should come from randomized controlled and adequately powered intervention studies.
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Emerging evidence has led to expansion of this concept to that of the brain-gut-kidney axis.
“Emerging evidence has led to expansion of this concept to that of the brain-gut-kidney axis9,118,160,161 (TABLE 2).”
From The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease (2018) · cites this paper as [9]
The gut-kidney axis can be subdivided into metabolism-dependent and immune pathways.
“The gut-kidney axis can be subdivided into metabolism-dependent and immune pathways9.”
From The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease (2018) · cites this paper as [9]
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Adijiang, A., & Niwa, T. (2009) · American Journal of Nephrology · doi:10.1159/000264634 · Cited by 41 · see citing works
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Viaene, L., Thijs, L., Jin, Y., Liu, Y., Gu, Y., Meijers, B. K. I., Claes, K. J., Staessen, J. A., & Evenepoel, P. (2014) · PLoS ONE · doi:10.1371/journal.pone.0079682 · Cited by 34 · see citing works
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Intestinal dialysis for kidney failure. Personal experience.
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Adverse Effects of Proton Pump Inhibitors in Chronic Kidney Disease
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Self-citation
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The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease
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NAFLD as a driver of chronic kidney disease
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Hu, D., Liu, W., Yu, W., Huang, L., Ji, C., Liu, X., & Lu, Z. (2023) · Renal Failure · doi:10.1080/0886022x.2023.2197076 · Cited by 21 · see citing works
- Authors
- Evenepoel, P., Poesen, R., & Meijers, B.
- Affiliations
- Universitair Ziekenhuis Leuven (BE)
- Corresponding author
- Evenepoel, Pieter
- Venue
- Pediatric Nephrology
- Published
- 2016-11-15
- Volume
- 32
- Issue
- 11
- Pages
- 2005-2014
- ISSN
- 0931-041X (ISSN-L)
- 1432-198X
- OpenAlex
- W2552030271
- Cited by
- 305
- References
- 95
- Citations by year
- 2026: 38 · 2025: 36 · 2024: 44 · 2023: 44 · 2022: 33 · 2021: 39 · 2020: 32 · 2019: 16 · 2018: 19 · 2017: 4
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pediatric Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- gut-kidney axis, gut microbiota, chronic kidney disease, uremic toxins, indoxyl sulfate, p-cresyl sulfate, trimethylamine N-oxide, gut dysbiosis, endotoxemia, epithelial barrier function, prebiotics, probiotics, dietary therapy, enzyme inhibitors, adjuvant therapy
- MeSH terms
- Gastrointestinal Microbiome, Animals, Humans, Kidney, Uremia, Gastrointestinal Tract, Renal Insufficiency, Chronic
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