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Review
. 2023 Dec 13;17(1):sfad303.
doi: 10.1093/ckj/sfad303. eCollection 2024 Jan.

Gut-immune axis and cardiovascular risk in chronic kidney disease

Felix Behrens  1   2   3   4 , Hendrik Bartolomaeus  2   3   5   6 , Nicola Wilck  2   3   5   6 , Johannes Holle  1   2   3   5
Affiliations
Review

Gut-immune axis and cardiovascular risk in chronic kidney disease

Felix Behrens et al. Clin Kidney J. .

Abstract

Patients with chronic kidney disease (CKD) suffer from marked cardiovascular morbidity and mortality, so lowering the cardiovascular risk is paramount to improve quality of life and survival in CKD. Manifold mechanisms are hold accountable for the development of cardiovascular disease (CVD), and recently inflammation arose as novel risk factor significantly contributing to progression of CVD. While the gut microbiome was identified as key regulator of immunity and inflammation in several disease, CKD-related microbiome-immune interaction gains increasing importance. Here, we summarize the latest knowledge on microbiome dysbiosis in CKD, subsequent changes in bacterial and host metabolism and how this drives inflammation and CVD in CKD. Moreover, we outline potential therapeutic targets along the gut-immune-cardiovascular axis that could aid the combat of CVD development and high mortality in CKD.

Keywords: cardiovascular disease; chronic kidney disease; immunity; inflammation; microbiome.

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Conflict of interest statement

None declared.

Figures

Figure 1:
Figure 1:
Cardiovascular disease in chronic kidney disease (CKD). Flowchart depicting CKD-related factors driving cardiovascular disease (CVD) processes that lead to a high frequency of CVD manifestations in CKD. Comorbidities refer to common conditions that coincide with CKD and also drive CVD, i.e. diabetes and hypertension. RAAS, renin–angiotensin–aldosterone system.
Figure 2:
Figure 2:
Gut-immune-cardiovascular axis in chronic kidney disease (CKD). Changes in diet, gut microbiome and metabolism drive cardiovascular disease (CVD) in CKD via dysregulation of intestinal function and inflammation. TEM, effector memory T cell; TMA(O), trimethylamine (N-oxide); Treg, regulatory T cell.
Figure 3:
Figure 3:
Microbiome-targeted therapy of cardiovascular disease (CVD). Dietary modifications, prebiotics and probiotics beneficially influence the microbiome and may form promising candidates to tackle dysbiosis-driven inflammation and subsequent CVD in CKD. Postbiotics, such as short-chain fatty acids, supplement beneficial microbial metabolites, likewise with positive effects on intestinal barrier function (leaky gut) and inflammation. All microbiome-targeted therapeutic strategies aim to improve inflammatory status and cardiovascular health, which is displayed schematically on the right.
See this image and copyright information in PMC

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References

    1. Jha V, Garcia-Garcia G, Iseki Ket al. . Chronic kidney disease: global dimension and perspectives. Lancet 2013;382:260–72. 10.1016/S0140-6736(13)60687-X - DOI - PubMed
    1. Gansevoort RT, Correa-Rotter R, Hemmelgarn BRet al. . Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet 2013;382:339–52. 10.1016/S0140-6736(13)60595-4 - DOI - PubMed
    1. van der Velde M, Matsushita K, Coresh Jet al. . Lower estimated glomerular filtration rate and higher albuminuria are associated with all-cause and cardiovascular mortality. A collaborative meta-analysis of high-risk population cohorts. Kidney Int 2011;79:1341–52. 10.1038/ki.2010.536 - DOI - PubMed
    1. Chronic Kidney Disease Prognosis Consortium, Matsushita K, van der Velde Met al. . Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet 2010;375:2073–81. 10.1016/S0140-6736(10)60674-5 - DOI - PMC - PubMed
    1. Goodman WG, Goldin J, Kuizon BDet al. . Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000;342:1478–83. 10.1056/NEJM200005183422003 - DOI - PubMed