Oh, My Gut! New insights on the role of the gastrointestinal tract and the gut microbiome in chronic kidney disease-mineral and bone disorder

Seyedeh Nooshan Mirmohammadali, Kathleen M.Hill Gallant, Annabel Biruete

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of reviewThe aim of this review is to highlight recent evidence on the role of the gastrointestinal tract and gut microbiome on chronic kidney disease-mineral bone disorder (CKD-MBD) outcomes, including intestinal phosphorus absorption and sensing, and the effect of gut-oriented therapies.Recent findingsRecent evidence has revealed a complex interplay among mineral metabolism and novel gut-related factors, including paracellular intestinal phosphate absorption, the gut microbiome, and the immune system, prompting a reevaluation of treatment approaches for CKD-MBD. The inhibition of NHE3 limits phosphate transport in the intestine and may lead to changes in the gut microbiome. A study in rats with CKD showed that the supplementation of the fermentable dietary inulin delayed CKD-MBD, lowering circulating phosphorus and parathyroid hormone, reducing bone remodeling and improving cortical parameters, and lowering cardiovascular calcifications. In non-CKD preclinical studies, probiotics and prebiotics improved bone formation mediated through the effect of butyrate facilitating the differentiation of T cells into Tregs, and Tregs stimulating the osteogenic Wnt10b, and butyrate was also necessary for the parathyroid hormone (PTH) bone effects.SummaryRecent findings support multiple possible roles for gut-oriented therapies in addressing CKD-MBD prevention and management that should be further explored through clinical and translational studies.

Original languageEnglish (US)
Pages (from-to)226-230
Number of pages5
JournalCurrent opinion in nephrology and hypertension
Volume33
Issue number2
DOIs
StatePublished - Mar 1 2024

Bibliographical note

Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • chronic kidney disease-mineral and bone disorder
  • dysbiosis
  • gut microbiome
  • paracellular
  • phosphorus

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, N.I.H., Extramural

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