An Overview of Chronic Kidney Disease Pathophysiology: The Impact of Gut Dysbiosis and Oral Disease

Abstract

Chronic kidney disease (CKD) is a severe condition and a significant public health issue worldwide, carrying the burden of an increased risk of cardiovascular events and mortality. The traditional factors that promote the onset and progression of CKD are cardiometabolic risk factors like hypertension and diabetes, but non-traditional contributors are escalating. Moreover, gut dysbiosis, inflammation, and an impaired immune response are emerging as crucial mechanisms in the disease pathology. The gut microbiome and kidney disease exert a reciprocal influence commonly referred to as “the gut-kidney axis” through the induction of metabolic, immunological, and endocrine alterations. Periodontal diseases are strictly involved in the gut-kidney axis for their impact on the gut microbiota composition and for the metabolic and immunological alterations occurring in and reciprocally affecting both conditions. This review aims to provide an overview of the dynamic biological interconnections between oral health status, gut, and renal pathophysiology, spotlighting the dynamic oral-gut-kidney axis and raising whether periodontal diseases and gut microbiota can be disease modifiers in CKD. By doing so, we try to offer new insights into therapeutic strategies that may enhance the clinical trajectory of CKD patients, ultimately advancing our quest for improved patient outcomes and well-being.

Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine

“…The gut microbiota plays a pivotal role in the production of uremic toxins, and it is intensely affected by the amount and kind of dietary protein and fibers [ 62 ]. In addition, intestinal microbiota impairment and kidney failure amplify each other: the retention of uremic toxins due to CKD impacts badly on the intestinal epithelial barrier, increasing uremic toxins’ production, which are involved in inflammation and fibrosis processes, which further worsens kidney function [ 63 ]. Therefore, lower removal and higher production are the main mechanisms of high levels of uremic toxins in CKD patients.…”

Association between gut microbiota and diabetic nephropathy: a mendelian randomization study

“…Gut microbiota (GM) has been found to participate in the pathogenesis of various ailments by influencing the permeability of the intestinal barrier, the inflammatory response, and the balance of the immunological microenvironment ( Lehto and Groop, 2018 ). Increasing evidence has suggested that the gut microbiota and kidney diseases can reciprocally influence each other through the induction of metabolic, immunological, and endocrine changes, a phenomenon commonly referred to as the “intestinal-renal axis” ( Altamura et al, 2023 ). Several studies have demonstrated the substantial importance of gut microbial dysbiosis in the initiation and deterioration of DN ( Wang Y. et al, 2022 ; Zhang et al, 2022 ; Zhao et al, 2023 ).…”

Evaluating the effect of vitamin D3 supplementation on DKK-3 serum for third-stage chronic kidney patients

“…Chronic kidney disease is described as an irreversible illness that lasts for at least three months and is brought on by a progressive loss of renal function (Altamura et al 2023). A glomerular filtration rate (GFR) consistently less than 60 ml/minute/1.73 m 2 (G3 stage) indicates chronic kidney disease (CKD).…”