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慢性肾脏病、肠道菌群失调与便秘:一个沉重的三联症

Chronic Kidney Disease, Gut Dysbiosis, and Constipation: A Burdensome Triplet.

作者信息

Ikee Ryota, Sasaki Naomi, Yasuda Takuji, Fukazawa Sawako

机构信息

Sapporo Nephrology Satellite Clinic, 9-2-15, Hassamu 6-jo, Nishi-ku, Sapporo 063-0826, Japan.

Sapporo Nephrology Clinic, 20-2-12, Nishimachikita, Nishi-ku, Sapporo 063-0061, Japan.

出版信息

Microorganisms. 2020 Nov 25;8(12):1862. doi: 10.3390/microorganisms8121862.


DOI:10.3390/microorganisms8121862
PMID:33255763
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7760012/
Abstract

Gut dysbiosis has been implicated in the progression of chronic kidney disease (CKD). Alterations in the gut environment induced by uremic toxins, the dietary restriction of fiber-rich foods, and multiple drugs may be involved in CKD-related gut dysbiosis. CKD-related gut dysbiosis is considered to be characterized by the expansion of bacterial species producing precursors of harmful uremic toxins, such as indoxyl sulfate and p-cresyl sulfate, and the contraction of species generating beneficial short-chain fatty acids, such as butyrate. Gut-derived uremic toxins cause oxidative stress and pro-inflammatory responses, whereas butyrate exerts anti-inflammatory effects and contributes to gut epithelial integrity. Gut dysbiosis is associated with the disruption of the gut epithelial barrier, which leads to the translocation of endotoxins. Research on CKD-related gut dysbiosis has mainly focused on chronic inflammation and consequent cardiovascular and renal damage. The pathogenic relationship between CKD-related gut dysbiosis and constipation has not yet been investigated in detail. Constipation is highly prevalent in CKD and affects the quality of life of these patients. Under the pathophysiological state of gut dysbiosis, altered bacterial fermentation products may play a prominent role in intestinal dysmotility. In this review, we outline the factors contributing to constipation, such as the gut microbiota and bacterial fermentation; introduce recent findings on the pathogenic link between CKD-related gut dysbiosis and constipation; and discuss potential interventions. This pathogenic link needs to be elucidated in more detail and may contribute to the development of novel treatment options not only for constipation, but also cardiovascular disease in CKD.

摘要

肠道微生物群失调与慢性肾脏病(CKD)的进展有关。尿毒症毒素、富含纤维食物的饮食限制以及多种药物引起的肠道环境改变可能与CKD相关的肠道微生物群失调有关。CKD相关的肠道微生物群失调被认为具有以下特征:产生有害尿毒症毒素前体(如硫酸吲哚酚和对甲酚硫酸盐)的细菌种类增加,以及产生有益短链脂肪酸(如丁酸)的细菌种类减少。肠道来源的尿毒症毒素会引起氧化应激和促炎反应,而丁酸则具有抗炎作用并有助于维持肠道上皮完整性。肠道微生物群失调与肠道上皮屏障的破坏有关,这会导致内毒素移位。关于CKD相关肠道微生物群失调的研究主要集中在慢性炎症以及随之而来的心血管和肾脏损害。CKD相关肠道微生物群失调与便秘之间的致病关系尚未得到详细研究。便秘在CKD患者中非常普遍,会影响这些患者的生活质量。在肠道微生物群失调的病理生理状态下,改变的细菌发酵产物可能在肠道运动障碍中起重要作用。在这篇综述中,我们概述了导致便秘的因素,如肠道微生物群和细菌发酵;介绍了关于CKD相关肠道微生物群失调与便秘之间致病联系的最新发现;并讨论了潜在的干预措施。这种致病联系需要更详细地阐明,可能有助于开发不仅针对便秘,而且针对CKD患者心血管疾病的新治疗方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b82/7760012/3991457f2eff/microorganisms-08-01862-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b82/7760012/3991457f2eff/microorganisms-08-01862-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5b82/7760012/3991457f2eff/microorganisms-08-01862-g001.jpg

相似文献

[1]
Chronic Kidney Disease, Gut Dysbiosis, and Constipation: A Burdensome Triplet.

Microorganisms. 2020-11-25

[2]
The Impact of CKD on Uremic Toxins and Gut Microbiota.

Toxins (Basel). 2021-3-31

[3]
Dietary strategies for gut-derived protein-bound uremic toxins and cardio-metabolic risk factors in chronic kidney disease: A focus on dietary fibers.

Crit Rev Food Sci Nutr. 2023

[4]
Altered microbiome in chronic kidney disease: systemic effects of gut-derived uremic toxins.

Clin Sci (Lond). 2018-3-9

[5]
Link between gut microbiota dysbiosis and chronic kidney disease.

Eur Rev Med Pharmacol Sci. 2022-3

[6]
The interplay among gut microbiota, hypertension and kidney diseases: The role of short-chain fatty acids.

Pharmacol Res. 2019-1-10

[7]
[Uremic toxins and gut micro biome].

Nihon Jinzo Gakkai Shi. 2017

[8]
[Pathomechanism and treatment of gut microbiota dysbiosis in chronic kidney disease and interventional effects of Chinese herbal medicine].

Zhongguo Zhong Yao Za Zhi. 2017-7

[9]
Oat Dietary Fiber Delays the Progression of Chronic Kidney Disease in Mice by Modulating the Gut Microbiota and Reducing Uremic Toxin Levels.

J Agric Food Chem. 2024-6-5

[10]
Gut microbiota in chronic kidney disease.

Nefrologia. 2017

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[2]
Gut microbiome remodeling in chronic kidney disease: implications of kidney replacement therapies and therapeutic interventions.

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[3]
Gut microbiota-derived SCFAs and MetS-related nephropathy.

Front Nutr. 2025-7-8

[4]
Gut microbiota-targeted therapies in pediatric chronic kidney disease: gaps and opportunities.

Pediatr Nephrol. 2025-5-1

[5]
Interest of inulin in obesity: comparison of the prebiotic effect of edible-food sources versus purified inulin from chicory root.

Eur J Nutr. 2025-4-5

[6]
Life's Simple 7 and its impact on chronic bowel disorders: a study on constipation and diarrhea in the U.S. adult population.

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[7]
Effects of Dietary Fiber Supplementation on Modulating Uremic Toxins and Inflammation in Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Toxins (Basel). 2025-1-26

[8]
Live and heat-killed Leuconostoc mesenteroides counteract the gastrointestinal dysfunction in chronic kidney disease mice through intestinal environment modulation.

PLoS One. 2025-2-24

[9]
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Gut Microbes. 2025-12

[10]
Curcumin modulated gut microbiota and alleviated renal fibrosis in 5/6 nephrectomy-induced chronic kidney disease rats.

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本文引用的文献

[1]
Influence of bowel habits on gut-derived toxins in peritoneal dialysis patients.

J Nephrol. 2020-10

[2]
Contribution of uremic dysbiosis to insulin resistance and sarcopenia.

Nephrol Dial Transplant. 2020-9-1

[3]
Influence of Exercise on the Human Gut Microbiota of Healthy Adults: A Systematic Review.

Clin Transl Gastroenterol. 2020-2

[4]
The Role of Gut Dysbiosis in the Bone-Vascular Axis in Chronic Kidney Disease.

Toxins (Basel). 2020-4-29

[5]
Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case-control study.

Nephrol Dial Transplant. 2021-5-27

[6]
Gut microbiota composition and frailty in elderly patients with Chronic Kidney Disease.

PLoS One. 2020-4-1

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Fruit and Vegetable Intake and Mortality in Adults undergoing Maintenance Hemodialysis.

Clin J Am Soc Nephrol. 2019-1-31

[8]
Quantitative reduction in short-chain fatty acids, especially butyrate, contributes to the progression of chronic kidney disease.

Clin Sci (Lond). 2019-9-10

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Impaired intestinal barrier function in a mouse model of hyperuricemia.

Mol Med Rep. 2019-8-12

[10]
The guanylate cyclase C agonist linaclotide ameliorates the gut-cardio-renal axis in an adenine-induced mouse model of chronic kidney disease.

Nephrol Dial Transplant. 2020-2-1

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