The kidney-gut axis: Implications for nutrition care

There is increasing clinical evidence that patients with chronic kidney disease (CKD) have a distinctly dysbiotic intestinal bacterial community, termed the gut microbiota, which in turn drives a cascade of metabolic abnormalities, including uremic toxin production, inflammation, and immunosuppression, that ultimately promotes progressive kidney failure and cardiovascular disease. As the gut microbiota is intimately influenced by diet, the discovery of the kidney-gut axis has created new therapeutic opportunities for nutritional intervention. This review discusses the metabolic pathways linking dysbiotic gut microbiota with adverse health outcomes in patients with CKD, as well as novel therapeutic strategies for targeting these pathways involving dietary protein, fiber, prebiotics, probiotics, and synbiotics. These emerging nutritional interventions may ultimately lead to a paradigm shift in the conventional focus of dietary management in CKD.