Nephrologist Sean Ye analyzed the vicious cycle problem of the "gut-kidney axis". He pointed out that declining kidney function and imbalance of intestinal flora may interact with each other, causing accumulation of urinary toxins and systemic inflammation, increasing the burden on the kidneys. (Provided by Annan Hospital)
When the kidneys start to "go on strike", it is not just the function of urinating and eliminating metabolic waste that is affected! Nephrologist Dr. Ye Shangen pointed out that recent studies have found that there is a two-way influence between chronic kidney disease and intestinal flora. Decreased kidney function will change the intestinal environment; while intestinal flora imbalance may increase the accumulation of urinary toxins and systemic inflammation, making the kidneys more burdened. This two-way interaction is called the "gut-kidney axis" and has gradually become an important research direction in the care of chronic kidney disease.
Ye Shangen said that there are trillions of bacteria living in the human intestinal tract. Some bacterial groups prefer to use sugars such as dietary fiber to produce metabolites that are beneficial to the intestines, which can be understood as "good bacteria"; other bacterial groups are more likely to utilize protein fermentation and produce urethane precursors, which can be regarded as relatively unfavorable "bad bacteria."
When kidney function declines, not only does the ability to eliminate urinary toxins become worse, it may also be accompanied by an imbalance in the intestinal flora, leading to the dilemma of "the kidneys cannot excrete, and the intestines produce more." The accumulation of urinary toxins will affect the intestinal barrier, leading to chronic inflammation throughout the body and deterioration of the metabolic environment, further increasing the burden on the kidneys and forming a vicious cycle.
Ye Shangen pointed out that in order to break the vicious cycle of intestinal and kidney problems, the diet can follow the two principles of "moderately limiting protein and increasing the proportion of plant foods." According to KDIGO kidney disease-related guidelines, patients with chronic kidney disease should adjust their protein intake according to the disease stage and nutritional status, and avoid excessive protein intake to avoid becoming a raw material for the synthesis of uremia; plant foods are rich in dietary fiber, which is beneficial to intestinal flora and maintains a healthy intestinal environment. However, lower protein is not always better. Excessive restriction may cause malnutrition and sarcopenia. Protein intake should be carried out under the guidance of a physician and nutritionist.
In addition to diet, there are also different treatment weapons for the vicious cycle of intestines and kidneys. Ye Shangen said that ketone amino acid preparations can rob nitrogen from uremic toxins through "transamination" and transform them into essential amino acids, which can kill two birds with one stone while supplementing nutrients and reducing the production of uremia; intestinal adsorbents are like "intestinal scavengers" and can absorb some uremic toxin precursors and reduce their absorption from the intestines. As for probiotics, they can improve the intestinal environment by adjusting the intestinal flora, but whether they can actually delay the deterioration of kidney function still needs to be confirmed by more research.
