Traditional Chinese medicine improved diabetic kidney disease through targeting gut microbiota

Abstract

Context

Diabetic kidney disease (DKD) affects nearly 40% of diabetic patients, often leading to end-stage renal disease that requires renal replacement therapies, such as dialysis and transplantation. The gut microbiota, an integral aspect of human evolution, plays a crucial role in this condition. Traditional Chinese medicine (TCM) has shown promising outcomes in ameliorating DKD by addressing the gut microbiota.

Objective

This review elucidates the modifications in gut microbiota observed in DKD and explores the impact of TCM interventions on correcting microbial dysregulation.

Methods

We searched relevant articles from databases including Web of Science, PubMed, ScienceDirect, Wiley, and Springer Nature. The following keywords were used: diabetic kidney disease, diabetic nephropathy, gut microbiota, natural product, TCM, Chinese herbal medicine, and Chinese medicinal herbs. Rigorous criteria were applied to identify high-quality studies on TCM interventions against DKD.

Results

Dysregulation of the gut microbiota, including Lactobacillus, Streptococcus, and Clostridium, has been observed in individuals with DKD. Key indicators of microbial dysregulation include increased uremic solutes and decreased short-chain fatty acids. Various TCM therapies, such as formulas, tablets, granules, capsules, and decoctions, exhibit unique advantages in regulating the disordered microbiota to treat DKD.

Conclusion

This review highlights the importance of targeting the gut-kidney axis to regulate microbial disorders, their metabolites, and associated signaling pathways in DKD. The Qing-Re-Xiao-Zheng formula, the Shenyan Kangfu tablet, the Huangkui capsule, and the Bekhogainsam decoction are potential candidates to address the gut-kidney axis. TCM interventions offer a significant therapeutic approach by targeting microbial dysregulation in patients with DKD.

Keywords:

• Chronic kidney disease
• intestinal epithelial cell barrier

Authors contributions

XQW and YYZ designed and wrote the review. XQW, LZ, and YLZ collected and analyzed the data. YLZ and XL revised the manuscript. XYH and LZ downloaded references and processed the figures and table in the manuscript. YYZ and XL supervised the draft preparation. All authors accepted the final version of the review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (Nos. 82104375, 82074002, and 82274079), Open Funds for the Shaanxi Provincial Key Laboratory of Infection and Immune Diseases (No. 2022-KFMS-5), Key Research and Development Plan of Shaanxi Province (No. 2021SF-380), and the Campus Research Project of Xi’an Peihua University (No. PHKT2322).