Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct;19(10):646-657.
doi: 10.1038/s41581-023-00736-7. Epub 2023 Jul 24.

Inflammation and gut dysbiosis as drivers of CKD-MBD

Pieter Evenepoel  1 , Peter Stenvinkel  2 , Catherine Shanahan  3 , Roberto Pacifici  4
Affiliations
Review

Inflammation and gut dysbiosis as drivers of CKD-MBD

Pieter Evenepoel et al. Nat Rev Nephrol. 2023 Oct.

Abstract

Two decades ago, Kidney Disease: Improving Global Outcomes coined the term chronic kidney disease-mineral and bone disorder (CKD-MBD) to describe the syndrome of biochemical, bone and extra-skeletal calcification abnormalities that occur in patients with CKD. CKD-MBD is a prevalent complication and contributes to the excessively high burden of fractures and cardiovascular disease, loss of quality of life and premature mortality in patients with CKD. Thus far, therapy has focused primarily on phosphate retention, abnormal vitamin D metabolism and parathyroid hormone disturbances, but these strategies have largely proved unsuccessful, thus calling for paradigm-shifting concepts and innovative therapeutic approaches. Interorgan crosstalk is increasingly acknowledged to have an important role in health and disease. Accordingly, mounting evidence suggests a role for both the immune system and the gut microbiome in bone and vascular biology. Gut dysbiosis, compromised gut epithelial barrier and immune cell dysfunction are prominent features of the uraemic milieu. These alterations might contribute to the inflammatory state observed in CKD and could have a central role in the pathogenesis of CKD-MBD. The emerging fields of osteoimmunology and osteomicrobiology add another level of complexity to the pathogenesis of CKD-MBD, but also create novel therapeutic opportunities.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Sarnak, M. J. et al. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 74, 1823–1838 (2019). - PubMed
    1. Yun, H. R. et al. Coronary artery calcification score and the progression of chronic kidney disease. J. Am. Soc. Nephrol. 33, 1590–1601 (2022). - PMC - PubMed
    1. Erlandsson, H. et al. Scoring of medial arterial calcification predicts cardiovascular events and mortality after kidney transplantation. J. Intern. Med. 291, 813–823 (2022). - PMC - PubMed
    1. Budoff, M. J. et al. Relationship of estimated GFR and coronary artery calcification in the CRIC (Chronic Renal Insufficiency Cohort) study. Am. J. Kidney Dis. 58, 519–526 (2011). - PMC - PubMed
    1. Moe, S. M. & Nickolas, T. L. Fractures in patients with CKD: time for action. Clin. J. Am. Soc. Nephrol. 11, 1929–1931 (2016). - PMC - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources