Kędzierska-Kapuza Karolina, Grudniewska Anna, Durma Anna, Małecki Robert, Franek Edward, Szczuko Małgorzata
Department of Internal Medicine, Endocrinology and Diabetology, National Medical Institute of the Ministry of Interior and Administration in Warsaw, 137 Wołoska Street, 02-507 Warsaw, Poland.
Lux Med Medical Centre in Warsaw, 49 Komitetu Obrony Robotników Street, 02-146 Warsaw, Poland.
J Clin Med. 2025 Jul 3;14(13):4701. doi: 10.3390/jcm14134701.
Type 2 diabetes (T2D) is the leading cause of chronic kidney disease (CKD), responsible for approximately 60% of cases. Diabetic kidney disease (DKD) affects 20-50% of individuals with diabetes, with diabetes-related ESKD cases rising steadily worldwide from 22.1% in 2000 to 31.3% in 2015. This review examines the literature published up to 25 February 2025, using a systematic search in PubMed and Scopus. Keywords included uremic toxins and diabetic kidney disease and/or gut microbiota, or dysbiosis or gut-kidney axis. Studies were independently assessed by a minimum of three authors, with discrepancies resolved through consensus. Gut microbiota dysbiosis is a key driver of DKD progression, making the gut-kidney axis a promising therapeutic target. A "nuts and fruits" dietary pattern reduces the DKD risk by 43.3%, while an animal protein intake lowers the diabetic peripheral neuropathy risk by 42.8%. High-fiber diets and supplements like resistant starch may reduce uremic toxins through microbiota modulation. Microbiota-targeted interventions, including probiotics, synbiotic, and dietary modifications, show potential in reducing uremic toxin production and inflammation, though DKD-specific evidence remains limited. and strains may help lower urea and creatinine levels, but outcomes vary by disease stage. Further research is needed to confirm the efficacy of dietary and probiotic approaches in DKD management.
2型糖尿病（T2D）是慢性肾脏病（CKD）的主要病因，约占病例的60%。糖尿病肾病（DKD）影响20%-50%的糖尿病患者，全球范围内与糖尿病相关的终末期肾病（ESKD）病例从2000年的22.1%稳步上升至2015年的31.3%。本综述检索了截至2025年2月25日发表的文献，在PubMed和Scopus数据库中进行了系统检索。关键词包括尿毒症毒素、糖尿病肾病和/或肠道微生物群、或生态失调或肠-肾轴。研究由至少三位作者独立评估，分歧通过协商解决。肠道微生物群生态失调是DKD进展的关键驱动因素，使肠-肾轴成为一个有前景的治疗靶点。“坚果和水果”饮食模式可使DKD风险降低43.3%，而动物蛋白摄入可使糖尿病周围神经病变风险降低42.8%。高纤维饮食和抗性淀粉等补充剂可通过调节微生物群减少尿毒症毒素。针对微生物群的干预措施，包括益生菌、合生元和饮食调整，在减少尿毒症毒素产生和炎症方面显示出潜力，尽管针对DKD的具体证据仍然有限。某些菌株可能有助于降低尿素和肌酐水平，但结果因疾病阶段而异。需要进一步研究以证实饮食和益生菌方法在DKD管理中的疗效。
