The role of gut dysbiosis in endocrine and metabolic derangements of chronic kidney disease: mechanisms, controversies, and future perspectives

作者：Ouyang Z, Hu W, Zhu F, Zhang Y, Wang L, Ye Q · 发表于：Frontiers in endocrinology · 年份：2026 · DOI：10.3389/fendo.2026.1854704 · 被引用次数：52 · 研究领域：chronic kidney disease、chronic kidney disease–mineral and bone disorder、endocrine-metabolic derangements、gut dysbiosis、gut–kidney axis、uremic toxins

Chronic kidney disease (CKD) is increasingly recognized as a systemic endocrine-metabolic disorder in which gut dysbiosis acts as a key amplifier of disease progression and complications. This mini-review summarizes current evidence linking alterations in gut microbial composition and function to major endocrine and metabolic derangements in CKD. Dysbiosis promotes the accumulation of gut-derived uremic toxins, including indoxyl sulphate, p-cresyl sulphate, and trimethylamine N-oxide, while reducing beneficial metabolites such as short-chain fatty acids, vitamin K, and protective tryptophan derivatives. Through interconnected pathways involving inflammation, oxidative stress, endothelial injury, immune dysregulation, and disturbed inter-organ signalling, these changes contribute to chronic kidney disease-mineral and bone disorder, vascular calcification, insulin resistance, protein-energy wasting, anaemia, and cognitive dysfunction. We further discuss major controversies, including the context-dependent role of trimethylamine N-oxide, the contested operational definition of "dysbiosis," and the clinical balance between low-protein dietary strategies and the risk of malnutrition, as well as the role of dietary fibre and whole-diet patterns. Practical diet-related approaches that translate these mechanistic findings into clinical practice are also outlined. Current limitations include incomplete mechanistic validation, limited longitudinal and interventional data, and inadequat...