Modulation of the Gut–Kidney Axis Through Probiotics and Synbiotics in Chronic Kidney Disease: A Narrative Review
https://doi.org/10.53770/medica.v8i9.1073
Keywords
Gut–Kidney Axis Probiotics Synbiotics Chronic Kidney Disease Gut MicrobiotaAbstract
Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality, partly mediated through disruption of the gut–kidney axis. Gut microbiota dysbiosis contributes to the accumulation of uremic toxins, systemic inflammation, and oxidative stress, thereby accelerating CKD progression. This narrative review summarizes current evidence on the role of probiotics and synbiotics in modulating the gut–kidney axis in CKD. Literature was identified through searches of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library up to April 2025, with emphasis on randomized controlled trials, systematic reviews, meta-analyses, and mechanistic studies. Current evidence indicates that probiotics and synbiotics may improve gut microbial balance, enhance short-chain fatty acid production, and reduce circulating uremic toxins and inflammatory markers. Additional approaches, including dietary interventions, fecal microbiota transplantation, and pharmacological modulation of the microbiome, have also shown potential benefits. However, despite favorable effects on surrogate biomarkers, evidence demonstrating significant improvements in kidney function and long-term clinical outcomes remains limited. Further well-designed randomized controlled trials with standardized formulations and clinically relevant endpoints are required to establish the therapeutic role of gut microbiota modulation as an adjunctive strategy in CKD management.
Downloads
References
Arteaga-Muller, G. Y., Flores-Treviño, S., Bocanegra-Ibarias, P., Robles-Espino, D., Garza-González, E., Fabela-Valdez, G. C., & Camacho-Ortiz, A. (2024). Changes in the progression of chronic kidney disease in patients undergoing fecal microbiota transplantation. Nutrients, 16(8), 1109. https://doi.org/10.3390/nu16081109
Bellizzi, V., Garofalo, C., Ferrara, C., & Calella, P. (2022). Ketoanalogue supplementation in patients with non-dialysis diabetic kidney disease: a systematic review and meta-analysis. Nutrients, 14(3), 441. https://doi.org/10.3390/nu14030441
Cahyadi, A., Yuwono, A., Subagio, S. W., & Iryaningrum, M. R. (2023). Gut dysbiosis and the role of probiotics in chronic kidney disease. Journal of the Medical Sciences (Berkala Ilmu Kedokteran), 55(3). https://doi.org/10.19106/JMedSci005503202309
Chen, C., Wang, J., Li, J., Zhang, W., & Ou, S. (2023). Probiotics, prebiotics, and synbiotics for patients on dialysis: a systematic review and meta-analysis of randomized controlled trials. Journal of Renal Nutrition, 33(1), 126–139. https://doi.org/10.1053/j.jrn.2022.04.001
Chen, Y.-Y., Chen, D.-Q., Chen, L., Liu, J.-R., Vaziri, N. D., Guo, Y., & Zhao, Y.-Y. (2019). Microbiome–metabolome reveals the contribution of gut–kidney axis on kidney disease. Journal of Translational Medicine, 17(1), 5. https://doi.org/10.1186/s12967-018-1756-4
Cooper, T. E., Khalid, R., Chan, S., Craig, J. C., Hawley, C. M., Howell, M., Johnson, D. W., Jaure, A., Teixeira-Pinto, A., & Wong, G. (2023). Synbiotics, prebiotics and probiotics for people with chronic kidney disease. Cochrane Database of Systematic Reviews, 2023(10). https://doi.org/10.1002/14651858.CD013631.pub2
Czaja-Stolc, S., Potrykus, M., Ruszkowski, J., Styburski, D., Dębska-Ślizień, A., & Małgorzewicz, S. (2025). The associations between nutrition and circulating gut microbiota-derived uremic toxins in patients undergoing kidney replacement therapy: An observational, cross-sectional study. Clinical Nutrition ESPEN, 65, 105–114. https://doi.org/10.1016/j.clnesp.2024.11.022
D’Alessandro, C., Giannese, D., Panichi, V., & Cupisti, A. (2023). Mediterranean dietary pattern adjusted for CKD patients: The MedRen diet. Nutrients, 15(5), 1256. https://doi.org/10.3390/nu15051256
De Mauri, A., Carrera, D., Bagnati, M., Rolla, R., Vidali, M., Chiarinotti, D., Pane, M., Amoruso, A., & Del Piano, M. (2022). Probiotics-supplemented low-protein diet for microbiota modulation in patients with advanced chronic kidney disease (ProLowCKD): Results from a placebo-controlled randomized trial. Nutrients, 14(8), 1637. https://doi.org/10.3390/nu14081637
Ebrahim, Z., Proost, S., Tito, R., Raes, J., Glorieux, G., Moosa, M., & Blaauw, R. (2022). The effect of ß-glucan prebiotic on kidney function, uremic toxins and gut microbiome in stage 3 to 5 chronic kidney disease (CKD) predialysis participants: a randomized controlled trial. Nutrients, 14(4), 805. https://doi.org/10.3390/nu14040805
Floch, M. H., Ringel, Y., & Walker, W. A. (Eds.). (2017). The microbiota in gastrointestinal pathophysiology: Implications for human health, prebiotics, probiotics, and dysbiosis. Elsevier.
Haller, D. (2018). The gut microbiome in health and disease. Springer.
Hsu, C.-K., Su, S.-C., Chang, L.-C., Yang, K.-J., Lee, C.-C., Hsu, H.-J., Chen, Y.-T., Sun, C.-Y., & Wu, I.-W. (2022). Oral absorbent AST-120 is associated with compositional and functional adaptations of gut microbiota and modification of serum short and medium-chain fatty acids in advanced CKD patients. Biomedicines, 10(9), 2234. https://doi.org/10.3390/biomedicines10092234
Hustrini, N. M., Susalit, E., & Rotmans, J. I. (2022). Prevalence and risk factors for chronic kidney disease in Indonesia: an analysis of the National Basic Health Survey 2018. Journal of Global Health, 12, 04074. https://doi.org/10.7189/jogh.12.04074
Inoshita, H., Asaoka, D., Matsuno, K., Yanagisawa, N., Suzuki, Y., & Miyauchi, K. (2023). Cross-sectional study on the association between dietary patterns and sarcopenia in elderly patients with chronic kidney disease receiving conservative treatment. Nutrients, 15(23), 4994. https://doi.org/10.3390/nu15234994
Jackson, R., Yao, T., Bulut, N., Cantu-Jungles, T. M., & Hamaker, B. R. (2024). Protein combined with certain dietary fibers increases butyrate production in gut microbiota fermentation. Food & Function, 15(6), 3186–3198. https://doi.org/10.1039/D3FO04187E
Kadatane, S. P., Satariano, M., Massey, M., Mongan, K., & Raina, R. (2023). The role of inflammation in CKD. Cells, 12(12), 1581. https://doi.org/10.3390/cells12121581
Koppe, L., & Soulage, C. O. (2022). The impact of dietary nutrient intake on gut microbiota in the progression and complications of chronic kidney disease. Kidney International, 102(4), 728–739. https://doi.org/10.1016/j.kint.2022.06.025
Krukowski, H., Valkenburg, S., Madella, A.-M., Garssen, J., Van Bergenhenegouwen, J., Overbeek, S. A., Huys, G. R. B., Raes, J., & Glorieux, G. (2023). Gut microbiome studies in CKD: Opportunities, pitfalls and therapeutic potential. Nature Reviews Nephrology, 19(2), 87–101. https://doi.org/10.1038/s41581-022-00647-z
Kwon, Y.-J., Joo, Y. S., Yun, H.-R., Lim, L. R., Yang, J., Lee, H. S., Kim, H.-M., Lee, H., Lee, J. E., & Lee, J.-W. (2024). Safety and impact of the Mediterranean diet in patients with chronic kidney disease: a pilot randomized crossover trial. Frontiers in Nutrition, 11, 1463502. https://doi.org/10.3389/fnut.2024.1463502
Lázaro, Á., Vila-Donat, P., & Manyes, L. (2024). Emerging mycotoxins and preventive strategies related to gut microbiota changes: probiotics, prebiotics, and postbiotics – a systematic review. Food & Function, 15(18), 8998–9023. https://doi.org/10.1039/D4FO01705F
Li, H.-B., Xu, M.-L., Xu, X.-D., Tang, Y.-Y., Jiang, H.-L., Li, L., Xia, W.-J., Cui, N., Bai, J., Dai, Z.-M., Han, B., Li, Y., Peng, B., Dong, Y.-Y., Aryal, S., Manandhar, I., Eladawi, M. A., Shukla, R., Kang, Y.-M., … Yang, T. (2022). Faecalibacterium prausnitzii Attenuates CKD via butyrate-renal GPR43 Axis. Circulation Research, 131(9). https://doi.org/10.1161/CIRCRESAHA.122.320184
Li, J., Shen, Y., Yan, K., Wang, S., Jiao, J., Chi, H., Zhong, J., Dong, Y., & Wang, P. (2024). The compositional and functional imbalance of the gut microbiota in CKD linked to disease patterns. Journal of Translational Medicine, 22(1), 773. https://doi.org/10.1186/s12967-024-05578-w
Liu, J., Zhong, J., Yang, H., Wang, D., Zhang, Y., Yang, Y., Xing, G., & Kon, V. (2022). Biotic supplements in patients with chronic kidney disease: meta-analysis of randomized controlled trials. Journal of Renal Nutrition, 32(1), 10–21. https://doi.org/10.1053/j.jrn.2021.08.005
Loscalzo, J., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Jameson, J. L. (Eds.). (2022). Harrison’s principles of internal medicine (21st edition). McGraw Hill.
Matsui, A., Yoshifuji, A., Irie, J., Tajima, T., Uchiyama, K., Itoh, T., Wakino, S., & Itoh, H. (2023). Canagliflozin protects the cardiovascular system through effects on the gut environment in non-diabetic nephrectomized rats. Clinical and Experimental Nephrology, 27(4), 295–308. https://doi.org/10.1007/s10157-022-02312-y
Młynarska, E., Budny, E., Saar, M., Wojtanowska, E., Jankowska, J., Marciszuk, S., Mazur, M., Rysz, J., & Franczyk, B. (2024). Does the composition of gut microbiota affect chronic kidney disease? molecular mechanisms contributed to decreasing glomerular filtration rate. International Journal of Molecular Sciences, 25(19), 10429. https://doi.org/10.3390/ijms251910429
Otani, H., Okada, T., Saika, Y., Sakagashira, M., Oda, H., Ito, Y., Yasuda, T., Kanno, T., Shimazui, M., Yamao, S., Kanazawa, Y., Shimode, M., Otani, M., Ueda, S., Nakao, T., & Yoshimura, A. (2023). Effect of nonsupplemented low-protein diet on the initiation of renal replacement therapy in stage 4 and 5 chronic kidney disease: a retrospective multicenter cohort study in Japan. Journal of Renal Nutrition, 33(5), 649–656. https://doi.org/10.1053/j.jrn.2023.05.001
Piccoli, G. B., Cederholm, T., Avesani, C. M., Bakker, S. J. L., Bellizzi, V., Cuerda, C., Cupisti, A., Sabatino, A., Schneider, S., Torreggiani, M., Fouque, D., Carrero, J. J., & Barazzoni, R. (2023). Nutritional status and the risk of malnutrition in older adults with chronic kidney disease – implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN. Clinical Nutrition, 42(4), 443–457. https://doi.org/10.1016/j.clnu.2023.01.018
Podadera-Herreros, A., Arenas-de Larriva, A. P., Gutierrez-Mariscal, F. M., Alcala-Diaz, J. F., Ojeda-Rodriguez, A., Rodriguez-Cantalejo, F., Cardelo, M. P., Rodriguez-Cano, D., Torres-Peña, J. D., Luque, R. M., Ordovas, J. M., Perez-Martinez, P., Delgado-Lista, J., Lopez-Miranda, J., & Yubero-Serrano, E. M. (2024). Mediterranean diet as a strategy for preserving kidney function in patients with coronary heart disease with type 2 diabetes and obesity: A secondary analysis of CORDIOPREV randomized controlled trial. Nutrition & Diabetes, 14(1), 27. https://doi.org/10.1038/s41387-024-00285-3
Ranganathan, N., & Anteyi, E. (2022). The role of dietary fiber and gut microbiome modulation in progression of chronic kidney disease. Toxins, 14(3), 183. https://doi.org/10.3390/toxins14030183
Stevens, P. E., Ahmed, S. B., Carrero, J. J., Foster, B., Francis, A., Hall, R. K., Herrington, W. G., Hill, G., Inker, L. A., Kazancıoğlu, R., Lamb, E., Lin, P., Madero, M., McIntyre, N., Morrow, K., Roberts, G., Sabanayagam, D., Schaeffner, E., Shlipak, M., … Levin, A. (2024). KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4), S117–S314. https://doi.org/10.1016/j.kint.2023.10.018
Tsuji, K., Uchida, N., Nakanoh, H., Fukushima, K., Haraguchi, S., Kitamura, S., & Wada, J. (2024). The gut–kidney axis in chronic kidney diseases. Diagnostics, 15(1), 21. https://doi.org/10.3390/diagnostics15010021
Tzatzaki, E., Didagelos, M., Karlafti, E., Melexopoulou, C., Tsavdaris, D., Ziakas, A., Marinaki, S., & Karvounis, H. (2024). Cardiac involvement in chronic kidney disease: epidemiology, pathophysiology, and complications. Heart Views, 25(4), 249–254. https://doi.org/10.4103/heartviews.heartviews_118_24
Wakino, S., Hasegawa, K., Tamaki, M., Minato, M., & Inagaki, T. (2025). Kidney-gut axis in chronic kidney disease: therapeutic perspectives from microbiota modulation and nutrition. Nutrients, 17(12), 1961. https://doi.org/10.3390/nu17121961
Wang, L., He, Y., Han, C., Zhu, P., Zhou, Y., Tang, R., & He, W. (2025). Global burden of chronic kidney disease and risk factors, 1990–2021: an update from the global burden of disease study 2021. Frontiers in Public Health, 13, 1542329. https://doi.org/10.3389/fpubh.2025.1542329
Wang, T., Masedunskas, A., Willett, W. C., & Fontana, L. (2023). Vegetarian and vegan diets: Benefits and drawbacks. European Heart Journal, 44(36), 3423–3439. https://doi.org/10.1093/eurheartj/ehad436
Williams, M. J., White, S. C., Joseph, Z., & Hruska, K. A. (2023). Updates in the chronic kidney disease-mineral bone disorder show the role of osteocytic proteins, a potential mechanism of the bone—Vascular paradox, a therapeutic target, and a biomarker. Frontiers in Physiology, 14, 1120308. https://doi.org/10.3389/fphys.2023.1120308
Yu, A. S. L., Chertow, G. M., Luyckx, V. A., Marsden, P. A., Skorecki, K., & Taal, M. W. (Eds.). (2020). Brenner & Rector’s the kidney (Eleventh edition). Elsevier.
Zarantonello, D., & Brunori, G. (2023). The role of plant-based diets in preventing and mitigating chronic kidney disease: more light than shadows. Journal of Clinical Medicine, 12(19), 6137. https://doi.org/10.3390/jcm12196137
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 MEDICA (International Medical Scientific Journal)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
