Journal
NUTRIENTS
Volume 13, Issue 4, Pages -Publisher
MDPI
DOI: 10.3390/nu13041273
Keywords
chronic kidney disease; microbiota; phosphate; uremic toxins; phosphate binder; short chain fatty acid; PTH
Categories
Funding
- European Union [860329]
- FIS/Fondos FEDER [PI18/01366, PI20/00744, PI19/00815, DTS18/00032]
- ERA-PerMed-JTC2018 (KIDNEY ATTACK) [AC18/00064]
- ERA-PerMed-JTC2018 (PERSTIGAN) [AC18/00071]
- ERA-PerMed-JTC2018 (ISCIII-RETIC REDinREN) [RD016/0009]
- Comunidad de Madrid en Biomedicina [B2017/BMD-3686 CIFRA2-CM]
- Sociedad Espanola de Nefrologia
- FRIAT
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Phosphate plays a crucial role in CKD-MBD and is treated through low phosphate diet and phosphate binders to manage hyperphosphatemia. Recent studies have identified a potential role of gut microbiota in mineral bone disorders, potentially influencing the effects of PTH on bone health.
Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventually, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.
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