Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Nutrition Post-Graduation Program, Universidade Federal de São Paulo, São Paulo, Brazil.
Eur J Clin Invest. 2021 Sep;51(9):e13588. doi: 10.1111/eci.13588. Epub 2021 Jun 7.
Deregulations in gut microbiota may play a role in vascular and bone disease in chronic kidney disease (CKD). As glomerular filtration rate declines, the colon becomes more important as a site of excretion of urea and uric acid, and an increased bacterial proteolytic fermentation alters the gut microbial balance. A diet with limited amounts of fibre, as well as certain medications (eg phosphate binders, iron supplementation, antibiotics) further contribute to changes in gut microbiota composition among CKD patients. At the same time, both vascular calcification and bone disease are common in patients with advanced kidney disease. This narrative review describes emerging evidence on gut dysbiosis, vascular calcification, bone demineralization and their interrelationship termed the 'gut-bone-vascular axis' in progressive CKD. The role of diet, gut microbial metabolites (ie indoxyl sulphate, p-cresyl sulphate, trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFA)), vitamin K deficiency, inflammatory cytokines and their impact on both bone health and vascular calcification are discussed. This framework may open up novel preventive and therapeutic approaches targeting the microbiome in an attempt to improve cardiovascular and bone health in CKD.
肠道微生物群的失调可能在慢性肾脏病（CKD）中的血管和骨骼疾病中起作用。随着肾小球滤过率的下降，结肠作为尿素和尿酸排泄的部位变得更加重要，而细菌蛋白水解发酵的增加改变了肠道微生物平衡。CKD 患者的饮食中纤维含量有限，以及某些药物（如磷酸盐结合剂、铁补充剂、抗生素）也会进一步导致肠道微生物群组成的变化。同时，血管钙化和骨骼疾病在晚期肾病患者中很常见。本综述描述了肠道菌群失调、血管钙化、骨脱矿质及其在进行性 CKD 中称为“肠道-骨骼-血管轴”的相互关系的新出现证据。讨论了饮食、肠道微生物代谢产物（即吲哚硫酸酯、对甲酚硫酸酯、三甲胺 N-氧化物（TMAO）和短链脂肪酸（SCFA））、维生素 K 缺乏、炎症细胞因子及其对骨骼健康和血管钙化的影响。该框架可能为针对微生物组的新型预防和治疗方法开辟途径，试图改善 CKD 中的心血管和骨骼健康。
