The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis

Abstract

Chronic kidney disease (CKD) is associated with an imbalanced human microbiome due not only to CKD-associated factors such as uremia, increased inflammation and immunosuppression, but also to pharmacological therapies and dietary restrictions. End-stage renal disease patients require renal replacement therapies commonly in the form of hemodialysis (HD) or peritoneal dialysis (PD). HD implies the existence of a vascular access, such as an arteriovenous fistula/graft or a venous catheter, whereas PD implies a long-term peritoneal catheter and the constant inflow of peritoneal dialysate. Also, dietary adaptations are mandatory in both therapies. This revision explores the impact of HD or PD therapies on human microbiome. HD and PD appear to be associated with different changes in the gut microbiome, for example a decrease in Proteobacteria relative abundance in HD patients and increase in PD patients. Both therapies may also have an impact on the human microbiome beyond the gut, leading to increased relative abundance of specific bacteria in the blood microbiome of HD patients and increased relative abundance of other bacteria in the peritoneal microbiome of PD patients. HD and PD catheter biofilms may also play an important role in the changes observed in these microbiomes. A more interdisciplinary approach is needed to further clarify the role of microbial groups other than bacteria in all body habitats to allow the complete understanding of the impact of HD or PD on the microbiome of CKD patients. Moreover, strategies that promote a healthy balance of the human microbiome on these patients should be explored.

Transplant associated infections—The role of the gastrointestinal microbiota and potential therapeutic options

“…The gut microbiome patterns in patients with dialysis‐dependent end‐stage kidney disease have been well documented in the literature. Compared with healthy individuals, haemodialysis patients exhibited a higher proportion of Proteobacteria, Actinobacteria and Firmicutes . Additionally, faecal analysis demonstrated reduced proportions of bacteria that were able to produce short chain fatty acid butyrate, which is known to be associated with immune regulation, iron absorption, inflammatory and oxidative stress and cell growth and differentiation .…”

“…Compared with healthy individuals, haemodialysis patients exhibited a higher proportion of Proteobacteria, Actinobacteria and Firmicutes. [31][32][33][34] Additionally, faecal analysis demonstrated reduced proportions of bacteria that were able to produce short chain fatty acid butyrate, which is known to be associated with immune regulation, iron absorption, inflammatory and oxidative stress and cell growth and differentiation. 35 In contrast, compared with individuals without end-stage kidney disease, peritoneal dialysis (PD) patients displayed a reduced abundance of Firmicutes and Actinobacteria, and an increased abundance of Proteobacteria.…”

“…35 In contrast, compared with individuals without end-stage kidney disease, peritoneal dialysis (PD) patients displayed a reduced abundance of Firmicutes and Actinobacteria, and an increased abundance of Proteobacteria. [31][32][33][34]…”

Microbiome–metabolomics reveals gut microbiota associated with glycine-conjugated metabolites and polyamine metabolism in chronic kidney disease

“…It has been reported that patients with ESRD have expansion of Firmicutes, Actinobacteria and Proteobacteria phyla and reduction of Bifidobacteria and Lactobacilli populations in their colons [9]. Several studies have also uncovered marked alteration of the microbiota composition in hemodialysis patients [10]. Alterations in microbiome composition results in increased generation of lipopolysaccharide, IS, p-CS, amines and ammonia that lead to the activation of proinflammatory cytokine/chemokine cascades in CKD and ESRD [11].…”

Peritoneal Microbiome in End-Stage Renal Disease Patients and the Impact of Peritoneal Dialysis Therapy

“…Disturbances in the normal gut microbiome are currently associated with the pathogenesis of several chronic diseases, including chronic kidney disease (CKD) [4][5][6][7][8][9][10][11][12]. Gut dysbiosis is well-described in CKD, characterized by lower levels of Bifidobacteriaceae and Lactobacillaceae and higher levels of Enterobacteriaceae [13,14]. The composition of this microbiome is also affected by renal replacement therapy (RRT) used by patients with end-stage kidney disease (ESKD).…”