Chapter 13 - The gut microbiome in chronic kidney disease

Chronic kidney disease (CKD) is a continuously growing public health problem, affecting nowadays 8% to 16% of the general adult population around the world. As in other chronic pathologies, CKD was recently associated with an unbalanced gut microbiome. Several CKD-associated factors contribute to gut dysbiosis in CKD patients, such as uremic toxin accumulation, chronic inflammatory status, pharmacologic therapies, dietary restrictions, CKD-associated comorbidities, and the renal replacement therapies that end-stage kidney disease patients are subject to. However, this CKD-induced gut dysbiosis will further potentiate CKD progression due to several processes, namely, the production of uremic toxins of microbial-origin, intensification of renal and systemic inflammation, and, consequent increase in the cardiovascular risk. This chapter will describe up-to-date knowledge on the intrinsic relationship between gut microbiome and CKD and will cover future strategies toward prevention and treatment of intestinal dysbiosis that may ameliorate CKD progression.