Servei de Nefrologia, Fundacio Puigvert, 08025 Barcelona, Spain.
Anemia Working Group of the Spanish Society of Nephrology, 39008 Santander, Spain.
Toxins (Basel). 2024 Nov 17;16(11):495. doi: 10.3390/toxins16110495.
The gut dysbiosis present in chronic kidney disease (CKD) has been associated with anemia. Factors such as the accumulation of gut-derived uremic toxins, increased gut barrier permeability-induced inflammation, and a reduced intestinal production of short-chain fatty acids (SCFAs), all associated with changes in the intestinal microbiota composition in CKD, may lead to the development or worsening of anemia in renal patients. Understanding and addressing these mechanisms related to gut dysbiosis in CKD patients can help to delay the development of anemia and improve its control in this population. One approach is to avoid or reduce the use of drugs linked to gut dysbiosis in CKD, such as phosphate binders, oral iron supplementation, antibiotics, and others, unless they are indispensable. Another approach involves introducing dietary changes that promote a healthier microbiota and/or using prebiotics, probiotics, or symbiotics to improve gut dysbiosis in this setting. These measures can increase the presence of SCFA-producing saccharolytic bacteria and reduce proteolytic bacteria, thereby lowering the production of gut-derived uremic toxins and inflammation. By ameliorating CKD-related gut dysbiosis, these strategies can also improve the control of renal anemia and enhance the response to erythropoiesis-stimulating agents (ESAs) in ESA-resistant patients. In this review, we have explored the relationship between gut dysbiosis in CKD and renal anemia and propose feasible solutions, both those already known and potential future treatments.
慢性肾脏病（CKD）中存在的肠道菌群失调与贫血有关。一些因素，如肠道来源的尿毒症毒素的积累、增加的肠道屏障通透性引起的炎症以及短链脂肪酸（SCFA）产生减少，这些都与 CKD 患者肠道微生物群组成的变化相关，可能导致肾脏患者发生或加重贫血。了解和解决 CKD 患者肠道菌群失调相关的这些机制，可以帮助延缓贫血的发展并改善该人群对贫血的控制。一种方法是避免或减少与 CKD 肠道菌群失调相关的药物的使用，如磷酸盐结合剂、口服铁补充剂、抗生素等，除非这些药物是必不可少的。另一种方法是通过引入促进更健康的微生物群的饮食变化，或者使用益生元、益生菌或共生菌来改善这种情况下的肠道菌群失调。这些措施可以增加产生 SCFA 的发酵细菌的存在，并减少蛋白水解细菌，从而降低肠道来源的尿毒症毒素和炎症的产生。通过改善 CKD 相关的肠道菌群失调，这些策略还可以改善对肾性贫血的控制，并增强对红细胞生成刺激剂（ESA）在 ESA 抵抗患者中的反应。在这篇综述中，我们探讨了 CKD 中肠道菌群失调与肾性贫血之间的关系，并提出了可行的解决方案，包括已经知道的和潜在的未来治疗方法。
