Gut microbiome and CKD progression How diet affects kidney function

Our diet not only forms the basis for our own metabolism but also for our gut microbiota: billions of microbes of different strains maintain an equilibrium that is influenced by the substrates available in our food. Plant-rich diets, such as the Mediterranean diet or the dietary approaches to stop hypertension (DASH) diet have positive effects on the cardiovascular risk that are also mediated via our microbiota. Plants contain indigestible fibers, which are fermented to short chain fatty acids (SCFA) in our gut by so-called saccharolytic bacteria. SCFA are essential to protect the gut epithelial barrier; however, uremic toxins are also products of bacterial metabolism. Chronic kidney disease (CKD) is accompanied by a damaged gut epithelial barrier; increased translocation of bacterial toxins causes inflammation, which promotes further loss of kidney function. This review shows the association between diet and the microbiome also in CKD and gives a perspective on how this knowledge could be used to slow CKD progression through dietary interventions.