The Influence of the Gut Microbiota and the Gut-Peritoneal Axis on Peritoneal Dialysis: A Literature Review
DOI:
https://doi.org/10.25796/bdd.v8i1.86213Keywords:
Gut microbiota, peritoneal microbiota, peritoneal dialysis, peritoneal membrane, peritonitis, dysbiosisAbstract
The gut microbiota corresponds to the entirety of the microbial flora present in the various sections of the intestine. It is altered in end-stage renal disease on peritoneal dialysis and may play a role in peritoneal physiology and possibly in the prognosis of peritoneal dialysis. Furthermore, until recently, the peritoneal cavity was considered a sterile environment. New studies challenge this dogma and identify a microbiome within this cavity in patients undergoing peritoneal dialysis and those with chronic kidney disease, even in the absence of a cavity breach. This review article aims to summarize the existing literature on the potential impact of the gut microbiota and the gut-peritoneal axis on the prognosis of peritoneal dialysis.
References
Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease. Nat Rev Microbiol. 2021;19:55–71.
Huttenhower C, Gevers D, Knight R, Abubucker S, Badger JH, Chinwalla AT, et al. Structure, function and diversity of the healthy human microbiome. Nature. 2012;486:207–14.
Magnúsdóttir S, Ravcheev D, de Crécy-Lagard V, Thiele I. Systematic genome assessment of B-vitamin biosynthesis suggests co-operation among gut microbes. Front Genet. 2015;6:148.
Kho ZY, Lal SK. The Human Gut Microbiome - A Potential Controller of Wellness and Disease. Front Microbiol. 2018;9:1835.
Rowland I, Gibson G, Heinken A, Scott K, Swann J, Thiele I, et al. Gut microbiota functions: metabolism of nutrients and other food components. Eur J Nutr. 2018;57:1–24.
Parada Venegas D, De la Fuente MK, Landskron G, González MJ, Quera R, Dijkstra G, et al. Short Chain Fatty Acids (SCFAs)-Mediated Gut Epithelial and Immune Regulation and Its Relevance for Inflammatory Bowel Diseases. Front Immunol. 2019;10:277.
Anitha M, Vijay–Kumar M, Sitaraman SV, Gewirtz AT, Srinivasan S. Gut Microbial Products Regulate Murine Gastrointestinal Motility via Toll-Like Receptor 4 Signaling. Gastroenterology. 2012;143:1006-1016.e4.
Li PK-T, Chow KM, Cho Y, Fan S, Figueiredo AE, Harris T, et al. ISPD peritonitis guideline recommendations: 2022 update on prevention and treatment. Perit Dial Int. 2022;42:110–53.
Taghavi M, Dratwa M. Overview of ISPD 2022 guideline recommendations for peritonitis prevention and treatment. Bulletin de la Dialyse à Domicile. 2022;5:93–103.
Chow KM, Li PK-T, Cho Y, Abu-Alfa A, Bavanandan S, Brown EA, et al. ISPD Catheter-related Infection Recommendations: 2023 Update. Perit Dial Int. 2023;43:201–19.
Morelle J, Stachowska-Pietka J, Öberg C, Gadola L, La Milia V, Yu Z, et al. ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention. Perit Dial Int. 2021;41:352–72.
Sampaio-Maia B, Simões-Silva L, Pestana M, Araujo R, Soares-Silva IJ. The Role of the Gut Microbiome on Chronic Kidney Disease. Adv Appl Microbiol. 2016;96:65–94.
Simões-Silva L, Araujo R, Pestana M, Soares-Silva I, Sampaio-Maia B. The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis. Pharmacol Res. 2018;130:143–51.
Stadlbauer V, Horvath A, Ribitsch W, Schmerböck B, Schilcher G, Lemesch S, et al. Structural and functional differences in gut microbiome composition in patients undergoing haemodialysis or peritoneal dialysis. Sci Rep. 2017;7:15601.
Sender R, Fuchs S, Milo R. Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLOS Biology. 2016;14:e1002533.
Adak A, Khan MR. An insight into gut microbiota and its functionalities. Cell Mol Life Sci. 2019;76:473–93.
Greenhalgh K, Meyer KM, Aagaard KM, Wilmes P. The human gut microbiome in health: establishment and resilience of microbiota over a lifetime. Environmental Microbiology. 2016;18:2103–16.
Rajilić-Stojanović M, de Vos WM. The first 1000 cultured species of the human gastrointestinal microbiota. FEMS Microbiol Rev. 2014;38:996–1047.
Hou K, Wu Z-X, Chen X-Y, Wang J-Q, Zhang D, Xiao C, et al. Microbiota in health and diseases. Sig Transduct Target Ther. 2022;7:1–28.
Voroneanu L, Burlacu A, Brinza C, Covic A, Balan GG, Nistor I, et al. Gut Microbiota in Chronic Kidney Disease: From Composition to Modulation towards Better Outcomes-A Systematic Review. J Clin Med. 2023;12:1948.
Ren Z, Fan Y, Li A, Shen Q, Wu J, Ren L, et al. Alterations of the Human Gut Microbiome in Chronic Kidney Disease. Adv Sci (Weinh). 2020;7:2001936.
Durand P-Y, Nicco C, Serteyn D, Attaf D, Edeas M. Microbiota Quality and Mitochondrial Activity Link with Occurrence of Muscle Cramps in Hemodialysis Patients using Citrate Dialysate: A Pilot Study. Blood Purification. 2018;46:301–8.
Huang H-W, Chen M-J. Exploring the Preventive and Therapeutic Mechanisms of Probiotics in Chronic Kidney Disease through the Gut–Kidney Axis. J Agric Food Chem. 2024;72:8347–64.
Huang Y, Xin W, Xiong J, Yao M, Zhang B, Zhao J. The Intestinal Microbiota and Metabolites in the Gut-Kidney-Heart Axis of Chronic Kidney Disease. Front Pharmacol. 2022 Mar 18;13:837500.
Stanford J, Charlton K, Stefoska-Needham A, Ibrahim R, Lambert K. The gut microbiota profile of adults with kidney disease and kidney stones: a systematic review of the literature. BMC Nephrology. 2020;21:215.
Gao Q, Li D, Wang Y, Zhao C, Li M, Xiao J, et al. Analysis of intestinal flora and cognitive function in maintenance hemodialysis patients using combined 16S ribosome DNA and shotgun metagenome sequencing. Aging Clin Exp Res. 2024;36:28.
Tamanai-Shacoori Z, Smida I, Bousarghin L, Loreal O, Meuric V, Fong SB, et al. Roseburia spp.: a marker of health? Future Microbiol. 2017;12:157–70.
Li J, Xing H, Lin W, Yu H, Yang B, Jiang C, et al. Specific gut microbiome and metabolome changes in patients with continuous ambulatory peritoneal dialysis and comparison between patients with different dialysis vintages. Front Med (Lausanne). 2023;10:1302352.
Lee Y, Chung SW, Park S, Ryu H, Lee H, Kim DK, et al. Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis. Sci Rep. 2019;9:10105.
Sugimoto M, Yasuda H, Andoh A. Nutrition status and Helicobacter pylori infection in patients receiving hemodialysis. World J Gastroenterol. 2018;24:1591–600.
Korucu B, Helvaci O, Sadioglu R, Ozbas B, Yeter H, Derici U. Can Helicobacter pylori Colonization Affect the Phosphate Binder Pill Burden in Dialysis Patients? Ther Apher Dial. 2020;24:380–6.
Li K-J, Chen L. Association between duration of dialysis and Helicobacter pylori infection in dialysis patients: a meta-analysis. Int Urol Nephrol. 2019;51:1361–70.
Lambert K, Rinninella E, Biruete A, Sumida K, Stanford J, Raoul P, et al. Targeting the Gut Microbiota in Kidney Disease: The Future in Renal Nutrition and Metabolism. Journal of Renal Nutrition. 2023;33:S30–9.
Amini Khiabani S, Asgharzadeh M, Samadi Kafil H. Chronic kidney disease and gut microbiota. Heliyon. 2023;9:e18991.
Williams JD, Craig KJ, Topley N, Von Ruhland C, Fallon M, Newman GR, et al. Morphologic changes in the peritoneal membrane of patients with renal disease. J Am Soc Nephrol. 2002;13:470–9.
Margetts PJ, Bonniaud P. Basic mechanisms and clinical implications of peritoneal fibrosis. Perit Dial Int. 2003;23:530–41.
Sherif AM, Nakayama M, Maruyama Y, Yoshida H, Yamamoto H, Yokoyama K, et al. Quantitative assessment of the peritoneal vessel density and vasculopathy in CAPD patients. Nephrol Dial Transplant. 2006;21:1675–81.
Guo S, Wu H, Ji J, Sun Z, Xiang B, Wu W, et al. Association between gut microbial diversity and technique failure in peritoneal dialysis patients. Ren Fail. 2023;45:2195014.
Zhu Y, He C, Li X, Cai Y, Hu J, Liao Y, et al. Gut microbiota dysbiosis worsens the severity of acute pancreatitis in patients and mice. J Gastroenterol. 2019;54:347–58.
Cattaneo A, Cattane N, Galluzzi S, Provasi S, Lopizzo N, Festari C, et al. Association of brain amyloidosis with pro-inflammatory gut bacterial taxa and peripheral inflammation markers in cognitively impaired elderly. Neurobiol Aging. 2017;49:60–8.
Zheng Q, Chen Y, Zhai Y, Meng L, Liu H, Tian H, et al. Gut Dysbiosis Is Associated With the Severity of Cryptogenic Stroke and Enhanced Systemic Inflammatory Response. Front Immunol. 2022;13:836820.
Mohr AE, Crawford M, Jasbi P, Fessler S, Sweazea KL. Lipopolysaccharide and the gut microbiota: considering structural variation. FEBS Lett. 2022;596:849–75.
de Lima SMA, Otoni A, Sabino A de P, Dusse LMS, Gomes KB, Pinto SWL, et al. Inflammation, neoangiogenesis and fibrosis in peritoneal dialysis. Clin Chim Acta. 2013;421:46–50.
Shi J, Yu M, Sheng M. Angiogenesis and Inflammation in Peritoneal Dialysis: The Role of Adipocytes. Kidney Blood Press Res. 2017;42:209–19.
Le Chatelier E, Nielsen T, Qin J, Prifti E, Hildebrand F, Falony G, et al. Richness of human gut microbiome correlates with metabolic markers. Nature. 2013;500:541–6.
Brown CT, Davis-Richardson AG, Giongo A, Gano KA, Crabb DB, Mukherjee N, et al. Gut microbiome metagenomics analysis suggests a functional model for the development of autoimmunity for type 1 diabetes. PLoS One. 2011;6:e25792.
Vojinovic D, Radjabzadeh D, Kurilshikov A, Amin N, Wijmenga C, Franke L, et al. Relationship between gut microbiota and circulating metabolites in population-based cohorts. Nat Commun. 2019;10:5813.
Fu J, Bonder MJ, Cenit MC, Tigchelaar EF, Maatman A, Dekens JAM, et al. The Gut Microbiome Contributes to a Substantial Proportion of the Variation in Blood Lipids. Circ Res. 2015;117:817–24.
Mishima E, Fukuda S, Mukawa C, Yuri A, Kanemitsu Y, Matsumoto Y, et al. Evaluation of the impact of gut microbiota on uremic solute accumulation by a CE-TOFMS-based metabolomics approach. Kidney Int. 2017;92:634–45.
Gryp T, Huys GRB, Joossens M, Van Biesen W, Glorieux G, Vaneechoutte M. Isolation and Quantification of Uremic Toxin Precursor-Generating Gut Bacteria in Chronic Kidney Disease Patients. Int J Mol Sci. 2020;21:1986.
Graboski AL, Redinbo MR. Gut-Derived Protein-Bound Uremic Toxins. Toxins. 2020;12:590.
Wang X, Yang S, Li S, Zhao L, Hao Y, Qin J, et al. Aberrant gut microbiota alters host metabolome and impacts renal failure in humans and rodents. Gut. 2020;69:2131–42.
Stepanova N. The Gut-Peritoneum Axis in Peritoneal Dialysis and Peritoneal Fibrosis. Kidney Med. 2023;5:100645.
Mutsaers HAM, Stribos EGD, Glorieux G, Vanholder R, Olinga P. Chronic Kidney Disease and Fibrosis: The Role of Uremic Retention Solutes. Front Med (Lausanne). 2015;2:60.
Zhang L, Xie F, Tang H, Zhang X, Hu J, Zhong X, et al. Gut microbial metabolite TMAO increases peritoneal inflammation and peritonitis risk in peritoneal dialysis patients. Transl Res. 2022;240:50–63.
Lee G, You HJ, Bajaj JS, Joo SK, Yu J, Park S, et al. Distinct signatures of gut microbiome and metabolites associated with significant fibrosis in non-obese NAFLD. Nat Commun. 2020;11:4982.
Tan J-Y, Tang Y-C, Huang J. Gut Microbiota and Lung Injury. Adv Exp Med Biol. 2020;1238:55–72.
Jacobs L, Clevenbergh P, Collart F, Brayer I, Mesquita M, Taghavi M, et al. [Negative impact of COVID-19 pandemic on peritonitis rate in peritoneal dialysis patients: Pleading for a continuous educational training]. Nephrol Ther. 2022;18:526–33.
Liao J-L, Zhang Y-H, Xiong Z-B, Hao L, Liu G-L, Ren Y-P, et al. The Association of Cognitive Impairment with Peritoneal Dialysis-Related Peritonitis. Perit Dial Int. 2019;39:229–35.
Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP. Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis. 2010;56:693–703.
Yang T, Richards EM, Pepine CJ, Raizada MK. The gut microbiota and the brain-gut-kidney axis in hypertension and chronic kidney disease. Nat Rev Nephrol. 2018;14:442–56.
Wang YF, Zheng LJ, Liu Y, Ye YB, Luo S, Lu GM, et al. The gut microbiota-inflammation-brain axis in end-stage renal disease: perspectives from default mode network. Theranostics. 2019;9:8171–81.
Zhu B, Shen J, Jiang R, Jin L, Zhan G, Liu J, et al. Abnormalities in gut microbiota and serum metabolites in hemodialysis patients with mild cognitive decline: a single-center observational study. Psychopharmacology (Berl). 2020;237:2739–52.
Wang J, Wu S, Zhang J, Li Y, Wu Y, Qi X. Correlation between gut microbiome and cognitive impairment in patients undergoing peritoneal dialysis. BMC Nephrol. 2023;24:360.
Lameire N, Van Biesen W. Epidemiology of peritoneal dialysis: a story of believers and nonbelievers. Nat Rev Nephrol. 2010;6:75–82.
Zha Y, Qian Q. Protein Nutrition and Malnutrition in CKD and ESRD. Nutrients. 2017;9:208.
Martín-del-Campo F, Batis-Ruvalcaba C, González-Espinoza L, Rojas-Campos E, Angel JR, Ruiz N, et al. Dietary micronutrient intake in peritoneal dialysis patients: relationship with nutrition and inflammation status. Perit Dial Int. 2012;32:183–91.
Szeto C-C, Kwan BC-H, Chow K-M, Law M-C, Li PK-T. Geriatric Nutritional Risk Index as a Screening Tool for Malnutrition in Patients on Chronic Peritoneal Dialysis. Journal of Renal Nutrition. 2010;20:29–37.
Müller M, Dahdal S, Saffarini M, Uehlinger D, Arampatzis S. Evaluation of Nutrition Risk Screening Score 2002 (NRS) assessment in hospitalized chronic kidney disease patient. PLOS ONE. 2019;14:e0211200.
Tian N, Yan Y, Chen N, Xu S, Chu R, Wang M, et al. Relationship between gut microbiota and nutritional status in patients on peritoneal dialysis. Sci Rep. 2023;13:1572.
Schindler R, Beck W, Deppisch R, Aussieker M, Wilde A, Göhl H, et al. Short bacterial DNA fragments: detection in dialysate and induction of cytokines. J Am Soc Nephrol. 2004;15:3207–14.
Szeto C-C, Lai K-B, Kwan BC-H, Chow K-M, Leung C-B, Law M-C, et al. Bacteria-derived DNA fragment in peritoneal dialysis effluent as a predictor of relapsing peritonitis. Clin J Am Soc Nephrol. 2013;8:1935–41.
Rothschild D, Weissbrod O, Barkan E, Kurilshikov A, Korem T, Zeevi D, et al. Environment dominates over host genetics in shaping human gut microbiota. Nature. 2018;555:210–5.
Ji J, Jin W, Liu S-J, Jiao Z, Li X. Probiotics, prebiotics, and postbiotics in health and disease. MedComm. 2023;4:e420.
Wegierska AE, Charitos IA, Topi S, Potenza MA, Montagnani M, Santacroce L. The Connection Between Physical Exercise and Gut Microbiota: Implications for Competitive Sports Athletes. Sports Med. 2022;52:2355–69.
Campaniello D, Corbo MR, Sinigaglia M, Speranza B, Racioppo A, Altieri C, et al. How Diet and Physical Activity Modulate Gut Microbiota: Evidence, and Perspectives. Nutrients. 2022;14:2456.
Motiani KK, Collado MC, Eskelinen J-J, Virtanen KA, Löyttyniemi E, Salminen S, et al. Exercise Training Modulates Gut Microbiota Profile and Improves Endotoxemia. Med Sci Sports Exerc. 2020;52:94–104.
Wu GD, Chen J, Hoffmann C, Bittinger K, Chen Y-Y, Keilbaugh SA, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science. 2011;334:105–8.
Muegge BD, Kuczynski J, Knights D, Clemente JC, González A, Fontana L, et al. Diet drives convergence in gut microbiome functions across mammalian phylogeny and within humans. Science. 2011;332:970–4.
David LA, Maurice CF, Carmody RN, Gootenberg DB, Button JE, Wolfe BE, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505:559–63.
Singh RK, Chang H-W, Yan D, Lee KM, Ucmak D, Wong K, et al. Influence of diet on the gut microbiome and implications for human health. J Transl Med. 2017;15:73.
Travis AC, Katz PO, Kane SV. Mentoring in gastroenterology. Am J Gastroenterol. 2010;105:970–2.
Wastyk HC, Fragiadakis GK, Perelman D, Dahan D, Merrill BD, Yu FB, et al. Gut-microbiota-targeted diets modulate human immune status. Cell. 2021;184:4137-4153.e14.
Suez J, Korem T, Zeevi D, Zilberman-Schapira G, Thaiss CA, Maza O, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181–6.
Ahmad SY, Friel J, Mackay D. The Effects of Non-Nutritive Artificial Sweeteners, Aspartame and Sucralose, on the Gut Microbiome in Healthy Adults: Secondary Outcomes of a Randomized Double-Blinded Crossover Clinical Trial. Nutrients. 2020;12:3408.
Wang I-K, Wu Y-Y, Yang Y-F, Ting I-W, Lin C-C, Yen T-H, et al. The effect of probiotics on serum levels of cytokine and endotoxin in peritoneal dialysis patients: a randomised, double-blind, placebo-controlled trial. Benef Microbes. 2015;6:423–30.
Full Text:
Submitted
Accepted
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Lucas Jacobs, Laura Mannie-Corbisier, Maxime Taghavi, Joëlle Nortier
This work is licensed under a Creative Commons Attribution 4.0 International License.
