title: Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target.
abstract: Also known as the "second human genome," the gut microbiome plays important roles in both the maintenance of health and the pathogenesis of disease. The symbiotic relationship between host and microbiome is disturbed due to the proliferation of dysbiotic bacteria in patients with chronic kidney disease (CKD). Fermentation of protein and amino acids by gut bacteria generates excess amounts of potentially toxic compounds such as ammonia, amines, thiols, phenols, and indoles, but the generation of short-chain fatty acids is reduced. Impaired intestinal barrier function in patients with CKD permits translocation of gut-derived uremic toxins into the systemic circulation, contributing to the progression of CKD, cardiovascular disease, insulin resistance, and protein-energy wasting. The field of microbiome research is still nascent, but is evolving rapidly. Establishing symbiosis to treat uremic syndrome is a novel concept, but if proved effective, it will have a significant impact on the management of patients with CKD.
authors.affiliation: Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC.
authors.forename: Ali
authors.initials: A
authors.lastname: Ramezani
authors.affiliation: Division of Nephrology, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Ouest-ersailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France; INSERM U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Villejuif, France.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Massy
authors.affiliation: Division of Nephrology, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Björn
authors.initials: B
authors.lastname: Meijers
authors.affiliation: Division of Nephrology, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.affiliation: Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium.
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
authors.affiliation: Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC. Electronic address: draj@mfa.gwu.edu.
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
mesh_terms: D018450:Disease Progression; D064806:Dysbiosis / Q000150:complications / Q000378:metabolism; D061345:Early Medical Intervention / Q000379:methods; D000069196:Gastrointestinal Microbiome / Q000502:physiology*; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy; D014511:Uremia / Q000378:metabolism
keywords: Gut microbiome; amine; ammonia; chronic kidney disease (CKD); end-stage renal disease (ESRD); indole; metabolome; microbial metabolite; p-cresyl sulfate (PCS); phenol; review; thiol; urea; uremic syndrome; uremic toxin