Department of Nephrology and Hypertension, IIS-Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, Av Reyes Católicos 2, 28040 Madrid, Spain.
Red de Investigacion Renal (REDINREN), Av Reyes Católicos 2, 28040 Madrid, Spain.
Nutrients. 2021 Apr 13;13(4):1273. doi: 10.3390/nu13041273.
Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventually, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.
磷酸盐是一种与不良结局相关的重要尿毒症毒素。随着慢性肾脏病（CKD）的进展，肾脏排泄过多膳食磷酸盐的能力下降，引发代偿性内分泌反应，导致 CKD 矿物质和骨代谢紊乱（CKD-MBD）。最终，高磷血症发展，低磷饮食和磷酸盐结合剂被开处方。最近的数据表明，肠道微生物群在矿物质骨疾病中可能发挥作用。因此，甲状旁腺激素（PTH）仅在其微生物群中富含诱导 Th17 细胞的分类丝状细菌的小鼠中引起骨丢失。此外，微生物群是 PTH 刺激骨形成和增加骨量所必需的，这依赖于细菌产生短链脂肪酸丁酸。我们综述了目前关于磷酸盐、微生物群和 CKD-MBD 之间关系的知识。主题包括 CKD 中特别感兴趣的微生物生物活性化合物、饮食磷酸盐和磷酸盐结合剂对肠道微生物群的影响、微生物群对 CKD-MBD 的调节以及通过将其他科学领域的概念（如优化磷利用和使用聚磷生物体）转化为临床实践，利用微生物群治疗 CKD-MBD 的潜在治疗用途。
