Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Nutrición Salvador Zubirán, Vasco de Quiroga No. 15. Tlalpan, 14080, Mexico City, Mexico.
Departamento de Farmacología, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No. 1. Tlalpan, 14080, Mexico City, Mexico.
Int Urol Nephrol. 2019 Dec;51(12):2209-2226. doi: 10.1007/s11255-019-02291-2. Epub 2019 Oct 1.
Chronic kidney disease (CKD) is a worldwide health problem, because it is one of the most common complications of metabolic diseases including obesity and type 2 diabetes. Patients with CKD also develop other comorbidities, such as hypertension, hyperlipidemias, liver and cardiovascular diseases, gastrointestinal problems, and cognitive deterioration, which worsens their health. Therapy includes reducing comorbidities or using replacement therapy, such as peritoneal dialysis, hemodialysis, and organ transplant. Health care systems are searching for alternative treatments for CKD patients to mitigate or retard their progression. One new topic is the study of uremic toxins (UT), which are excessively produced during CKD as products of food metabolism or as a result of the loss of renal function that have a negative impact on the kidneys and other organs. High urea concentrations significantly modify the microbiota in the gut also, cause a decrease in bacterial strains that produce anti-inflammatory and fuel molecules and an increase in bacterial strains that can metabolize urea, but also produce UT, including indoxyl sulfate and p-cresol sulfate. UT activates several cellular processes that induce oxidative environments, inflammation, proliferation, fibrosis development, and apoptosis; these processes mainly occur in the gut, heart, and kidney. The study of the microbiota during CKD allowed for the implementation of therapy schemes to try to reduce the circulating concentrations of UT and reduce the damage. The objective of this review is to show an overview to know the main UT produced in end-stage renal disease patients, and how prebiotics and probiotics intervention acts as a helpful tool in CKD treatment.
慢性肾脏病（CKD）是一个全球性的健康问题，因为它是包括肥胖和 2 型糖尿病在内的代谢疾病的最常见并发症之一。CKD 患者还会出现其他合并症，如高血压、高血脂、肝和心血管疾病、胃肠道问题和认知能力下降，这会进一步恶化他们的健康状况。治疗包括减少合并症或使用替代疗法，如腹膜透析、血液透析和器官移植。医疗保健系统正在寻找 CKD 患者的替代治疗方法，以减轻或延缓其进展。一个新的话题是研究尿毒症毒素（UT），这些毒素在 CKD 期间作为食物代谢的产物或由于肾功能丧失而过度产生，对肾脏和其他器官有负面影响。高尿素浓度也显著改变了肠道中的微生物群，导致产生抗炎和燃料分子的细菌菌株减少，而能够代谢尿素但也产生 UT 的细菌菌株增加，包括吲哚硫酸酯和对甲酚硫酸盐。UT 激活了几种细胞过程，诱导氧化环境、炎症、增殖、纤维化发展和细胞凋亡；这些过程主要发生在肠道、心脏和肾脏中。在 CKD 期间对微生物群的研究使得可以实施治疗方案，以尝试降低循环中 UT 的浓度并减少损伤。本综述的目的是提供一个概述，以了解终末期肾病患者产生的主要 UT，以及益生元和益生菌干预如何作为 CKD 治疗的有用工具。
