Gut microbiome alterations predict diabetic kidney disease in general population

Abstract

Background Diabetic kidney disease (DKD) is increasingly prevalent owing to worldwide epidemic of diabetes mellitus (DM). The relationship between gut microbiome and chronic kidney disease (CKD) has attached wide attention during recent years. While the role of gut microbiome in diagnosis of DKD remains unclear. Methods We collected fecal samples of 180 patients with DKD and 179 healthy controls (Con) and characterized microbial profile using 16S rRNA gene sequencing approach. Microbial communities between the two groups were compared by Wilcoxon test. Two microbial models were identified by cross-validation preformed on random forest analysis. Diagnostic value of the two models was assessed in the training set including 118 DKDs and 132 healthy controls and validated in testing set composed of 62 DKDs and 47 healthy controls. PICRUSt was exploited to compare the potential metabolic function of microbiota between two groups. Results Compared with healthy controls, bacterial diversity in DKDs was decreased. Beta diversity showed markedly separating distribution between DKDs and Con groups. At the phylum level, DKD patients showed higher proportion of Proteobacteria, Verrucomicrobia and lower proportion of Bacteroidetes. In more details at the genus level, increase of opportunistic pathogens (including Escherichia-Shigella, Klebsiella, Enterococcus, Erysipelotrichaceae_incertae_sedis, Peptostreptococcaceae_incertae_sedis, Streptococcus) and mucin-degrading bacteria (including Akkermansia, Lactobacillus),as well as reduction of bacteria producing short-chain fatty acids (SCFA) such as Blautia༌Faecalibacterium were also observed in DKDs. The optimal prediction model consisting of 5 OTUs could distinguish DKD from healthy controls with an area under the ROC curve of 83.71% in training set and 81.56% in testing set, while another 22 OTUs couldn’t significantly improve diagnostic efficiency. Genomic metabolism associated with lipid and aromatic amino acids was over-expressed in DKD vs. Con. Conclusion Gut microbiome was altered in DKD patients. Our study suggested that gut microbiome may provide a potential tool for DKD diagnosis, especially those who could not accept or afford renal biopsy.

Faecal Microbiota Transplantation and Chronic Kidney Disease

“…Patients with DKD had a higher abundance of Verrucomicrobia, Proteobacteria, and a lower amount of Bacteroidetes at the phylum level, with Escherichia-Shigella, Enter Klebsiella, Streptococcus, Akkermansia, and lactobacillus increased at the genus level. In particular, SCFA-producing bacteria, such as Blautia and Faecalibacterium, were decreased in DKD patients compared to healthy controls [54]. Kim et al analysed the gut microbiome from 103 patients with CKD (stage 1 to 5) and 46 healthy controls.…”