Gut Microbiota Dysbiosis Significantly Influences Chronic Kidney Disease Progression

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Microbiota-based interventions may be a novel strategy to benefit the mitigation of chronic kidney disease advancement.

A recent retrospective cohort study provided updated insight into the characterization of gut microbiota among patients with stage 3 to 4 chronic kidney disease (CKD), and the potential for novel strategies to mitigate disease progression.1

Among a cohort of patients with CKD, and a subsequent group of healthy controls, the retrospective analysis identified the influence of imbalances in the gut microbiota in driving the progression of CKD.

“The distinct microbial profiles observed in patients with CKD highlight the potential efficacy of microbiota-based interventions in mitigating CKD advancement,” wrote the investigative team, led by Xiali Yang, department of nephrology in The First Affiliated Hospital of Xiamen University.

Patient factors, including dietary patterns and exposure to unfavorable substances, as well as pharmaceutical interventions, exhibit the ability to influence the composition of the gut microbiota.2 Regarding the progression of CKD, dysbiosis in the gut microbiota is considered a significant contributor to both the disease and its relevant complications.

With an improved understanding of the complexities involved in the intestinal microbiota, Yang and colleagues noted this research has the potential to provide novel perspectives on new, potential strategies for the mitigation of CKD progression.1 In the retrospective analysis, Yang and colleagues evaluated gut microbiota composition in patients with CKD.

The investigative team collected fecal samples from a cohort of 44 patients with stage 3 to stage 4 CKD, adjacent to a healthy control group consisting of 132 volunteers without CKD. In addition, investigators performed subsequent 16 s rDNA sequencing in order to examine the composition of the gut microbiota.

Upon analysis, Yang and colleagues found significant alterations in the diversity of intestinal microbiota among fecal samples between patients with stage 3 to 4 CKD and healthy participants. The analysis revealed, that among the 475 bacterial genera, a total of 164 were shared. A total of 242 dominant genera were noted as exclusive to healthy participants and 69 genera were exclusive to CKD stage 3 to 4 samples.

Yang and colleagues noted healthy volunteers showed a prevalence of intestinal Firmicutes and Bacteroidetes, while stage 3 to 4 patients with CKD showed higher rates of Proteobacteria and Actinobacteria. Meanwhile, the existence of uncultured Coprobacillus sp. added to the distinguishing between the two groups.

Further, Receiver Operating Characteristic (ROC) curve analysis revealed distinct microbiota with superior diagnostic efficacy for determining stage 3 to 4 patients with CKD from the healthy control participants. The investigative team also noted metabolic pathway analysis showed differing dominant pathways between patients with CKD and healthy controls.

These included the NADH dehydrogenase pathway among healthy individuals and the phosphate acetyltransferase pathway among stage 3 to 4 patients with CKD. Those in the CKD cohort also exhibited a higher proportion of Gram-negative bacteria and facultative anaerobes.

“In conclusion, our study underscores the profound influence of gut microbiota dysbiosis on CKD progression,” investigators wrote.


  1. Yang, X., Cai, S., Gong, J. et al. Characterization of gut microbiota in patients with stage 3–4 chronic kidney disease: a retrospective cohort study. Int Urol Nephrol (2023).
  2. Amini Khiabani S, Asgharzadeh M, Samadi Kafil H. Chronic kidney disease and gut microbiota. Heliyon. 2023;9(8):e18991. Published 2023 Aug 7. doi:10.1016/j.heliyon.2023.e18991