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Am J Kidney Dis. 2016 Mar;67(3):483-98. doi: 10.1053/j.ajkd.2015.09.027. Epub 2015 Nov 15.

Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target.

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Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC.
Division of Nephrology, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris Ouest-ersailles-Saint-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France; INSERM U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, University of Paris Ouest-Versailles-Saint-Quentin-en-Yvelines (UVSQ), Villejuif, France.
Division of Nephrology, Department of Microbiology and Immunology, University Hospitals Leuven, Leuven, Belgium.
Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium.
Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC. Electronic address:


Also known as the "second human genome," the gut microbiome plays important roles in both the maintenance of health and the pathogenesis of disease. The symbiotic relationship between host and microbiome is disturbed due to the proliferation of dysbiotic bacteria in patients with chronic kidney disease (CKD). Fermentation of protein and amino acids by gut bacteria generates excess amounts of potentially toxic compounds such as ammonia, amines, thiols, phenols, and indoles, but the generation of short-chain fatty acids is reduced. Impaired intestinal barrier function in patients with CKD permits translocation of gut-derived uremic toxins into the systemic circulation, contributing to the progression of CKD, cardiovascular disease, insulin resistance, and protein-energy wasting. The field of microbiome research is still nascent, but is evolving rapidly. Establishing symbiosis to treat uremic syndrome is a novel concept, but if proved effective, it will have a significant impact on the management of patients with CKD.


Gut microbiome; amine; ammonia; chronic kidney disease (CKD); end-stage renal disease (ESRD); indole; metabolome; microbial metabolite; p-cresyl sulfate (PCS); phenol; review; thiol; urea; uremic syndrome; uremic toxin

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