REVIEW  CONSERVATIVE MANAGEMENT OF CHRONIC KIDNEY DISEASE: HOW TO AVOID OR DEFER DIALYSIS 

Panminerva Medica 2017 June;59(2):173-87

DOI: 10.23736/S0031-0808.16.03282-1

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Microbiota and prebiotics modulation of uremic toxin generation

Laetitia KOPPE, Denis FOUQUE ✉

Department of Nephrology, Centre Hospitalier Lyon Sud, Cardiovascular, Metabolism, Diabetology and Nutrition (CarMeN) Lab, European Center for Nutrition and Health (CENS), University of Lyon, Lyon, France

Recent data have shown that the host-intestinal microbiota interaction is intrinsically linked with overall health. Chronic kidney disease (CKD) could influence intestinal microbiota and gut dysbiosis is also considered as a cause of progression of kidney disease. An increasing body of evidence indicates that dysbiosis is a key contributor of uremic retention solutes (URS) accumulating in patients with CKD. The discovery of the kidney-gut axis has created new therapeutic opportunities for nutritional intervention in order to prevent adverse outcomes. One of these strategies is prebiotics, which refers to nondigestible food ingredients or substances that beneficial affect growth and/or activity of limited health-promoting bacteria in the gastrointestinal tract. The influence of prebiotics on the production and concentration of URS have been investigated in various animal and human CKD studies. However, to date, there is still paucity of high-quality intervention trials. Randomized controlled trials and adequately powered intervention studies are needed before recommending prebiotics in clinical practice. This review will outline the interconnection between CKD progression, dysbiosis and URS production and will discuss mechanisms of action and efficacy of prebiotics as a new CKD management tool, with a particular emphasis on URS generation.

KEY WORDS: Microbiota - Probiotics - Uremia middle molecule toxins - Chronic kidney disease-mineral and bone disorder