i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Portugal; Faculty of Medicine, University of Porto, Portugal.
i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal; Flinders University, Dept. Medical Biotechnology, South Australia, Australia.
Pharmacol Res. 2018 Apr;130:143-151. doi: 10.1016/j.phrs.2018.02.011. Epub 2018 Feb 11.
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.
慢性肾脏病（CKD）与人类微生物组失衡有关，这不仅与 CKD 相关因素有关，如尿毒症、炎症增加和免疫抑制，还与药物治疗和饮食限制有关。终末期肾病患者通常需要肾脏替代治疗，形式通常为血液透析（HD）或腹膜透析（PD）。HD 意味着存在血管通路，例如动静脉瘘/移植物或静脉导管，而 PD 则意味着长期的腹膜导管和腹膜透析液的持续流入。此外，两种疗法都需要进行饮食调整。本综述探讨了 HD 或 PD 治疗对人类微生物组的影响。HD 和 PD 似乎与肠道微生物组的不同变化有关，例如 HD 患者中变形菌相对丰度的减少和 PD 患者中变形菌相对丰度的增加。这两种疗法也可能对肠道以外的人类微生物组产生影响，导致 HD 患者血液微生物组中特定细菌的相对丰度增加，PD 患者腹膜微生物组中其他细菌的相对丰度增加。HD 和 PD 导管生物膜也可能在这些微生物组中观察到的变化中起重要作用。需要采取更具跨学科性的方法，以进一步阐明除细菌以外的微生物群体在所有身体栖息地中的作用，从而全面了解 HD 或 PD 对 CKD 患者微生物组的影响。此外，应探索促进这些患者的人类微生物组健康平衡的策略。
