Gut-kidney axis (GKA)

The gut-kidney axis refers to the complex, bidirectional communication system between the gastrointestinal tract, its resident microbiota, and the kidneys, playing a vital role in maintaining systemic metabolic and immune homeostasis [1, 7]. Under physiological conditions, the gut microbiota produces beneficial metabolites such as short-chain fatty acids (SCFAs) that support intestinal barrier integrity and modulate immune responses [7, 10]. In the context of chronic kidney disease (CKD), the accumulation of urea and other waste products leads to gut dysbiosis, characterized by an overgrowth of toxin-producing bacteria and increased intestinal permeability [1, 10]. This 'leaky gut' allows the translocation of uremic toxins like indoxyl sulfate (IS) and p-cresyl sulfate (PCS) into the bloodstream, which exacerbates renal inflammation, oxidative stress, and fibrosis [2, 10]. Therapeutic interventions targeting this axis, such as oral adsorbents (e.g., AST-120), probiotics, and dietary modifications, aim to reduce the production of harmful metabolites and restore the gut barrier to slow the progression of renal decline [7, 8].

Other names

Gut-renal axisMicrobiota-gut-kidney axisGut-immune-kidney axisGut-vascular-kidney axis

Modulation of gut microbiota composition, reduction of uremic toxin production (e.g., indoxyl sulfate, p-cresyl sulfate), improvement of intestinal barrier integrity, and reduction of systemic inflammation [7, 8, 10].