Specific alterations in gut microbiota in patients with chronic kidney disease: an updated systematic review

Figures & data

Figure 1. Vicious circle of gut dysbiosis and chronic kidney diseases. The solid line shows the effect of gut dysbiosis on kidney disease, while the dotted line shows the effect of kidney disease on intestinal flora. Metabolic related kidney disease mainly includes chronic kidney disease, diabetes nephropathy, and nephrolithiasis, etc. Immune related chronic kidney disease mainly includes IgA nephropathy, lupus nephritis, and diabetes nephropathy, etc. Neuroendocrine related kidney disease mainly includes diabetes nephropathy.

Figure 2. Study selection flowchart.

Table 1. Characteristics of studies included in this review.

Study	Year	Region	Center number	Disease/severity	n (case)	n (control)	Hemodialysis	Peritoneal dialysis	Kidney transplant	No dialysis
Wang et al.	2012	Shaanxi, China	1	ESRD	30	10	0	0	0	30
Wang et al.	2012	Taiwan, China	1	ESRD	29	41	0	29	0	0
Vaziri et al.	2013	California, USA	1	ESRD	24	12	24	0	0	0
Jiang et al.	2017	Guangdong, China	1	ESRD	52	60	0	0	0	52
Vanessa et al.	2017	Graz, Austria	1	ESRD	30	21	15	15	0	0
Ye et al.	2018	Guangdong, China	1	ESRD	100	53	84	0	16	0
Li et al.	2019	Shandong, China	1	ESRD	53	69	29	24	0	0
Terpstra et al.	2019	Amsterdam, Netherlands	1	ESRD	35	15	31	0	4	0
Wang et al.	2020	Beijing, China	4	ESRD	223	69	223	0	0	0
Total			12		575	350	406	68	20	82
Barros et al.	2015	Niterói, RJ, Brazil	1	CKD stage 3–4	20	19	0	0	0	20
Margiotta et al.	2020	Milano, Italy	1	CKD stage 3b–4	64	15	0	0	0	64
Xu et al.	2017	Guangdong, China	1	CKD stage 4–5	32	32	0	0	0	32
Salguero et al.	2019	Texas, USA	1	CKD stage 4–5 & T2DM	20	20	0	0	0	20
Al-Obaide et al.	2017	Texas, USA	1	CKD stage 4–5 & T2DM	20	20	0	0	0	20
Li et al.	2019	Shanxi, China	1	CKD stage 3–5	50	22	0	0	0	50
Jiang et al.	2016	Guangdong, China	1	CKD stage 1–5	65	20	0	0	0	65
Lun et al.	2018	Shandong, China	1	CKD stage 1–5	49	24	13	0	0	36
Wang et al.	2019	Guangdong, China	1	CKD stage 1–5	128	63	0	0	0	128
Wu et al.	2020	Taiwan, China	1	CKD stage 1–5	92	30	–	–	0	–
Hu et al.	2020	Hunan, China	1	CKD stage 1–5	95	20	0	0	0	95
Ren et al.	2020	Zhengzhou, China	1	CKD stage 1–5	110	210	0	0	0	110
Total			12		635	285	13	0	0	530
De Angelis et al.	2014	Bari, Italy	1	IgAN	32	16	0	0	0	32
Hu et al.	2020	Hunan, China	1	IgAN	17	18				17
Zhong et al.	2020	Sichuan, China	1	IgAN	52	25	0	0	0	52
Tao et al.	2019	Chengdu, China	1	DN	14	14	0	0	0	14
Total			28		1436	918	419	68	20	837

ESRD: end-stage renal disease; CKD: chronic kidney disease; T2DM: type 2 diabetes mellitus; IgAN: IgA nephropathy; DN: diabetic nephropathy.

All studies were conducted in adults.

Table 2. Characteristics of intestinal microbiota of patients with CKD and ESRD compared to healthy controls.

Characteristics of intestinal microbiota of patients with CKD
Alpha diversity	66.6% (6/9) studies showed lower richness compared to healthy controls
Beta diversity	90.9% (10/11) studies showed distinct bacterial composition from healthy controls
Alteration of taxa	More abundant	Less abundant
Phylum	Proteobacteria and Fusobacteria	Synergistetes
Class	Bacteroidia, Gammaproteobacteria, Fusobacteria, and Actinobacteria	Betaproteobacteria and Verrucomicrobiae
Order	Enterobacteriales and Coriobacteriales	Clostridiales, Burkholderiales, and Verrucomicrobiales
Family	Enterococcaceae and Fusobacteriaceae	Prevotellaceae, Lachnospiraceae, Synergistaceae, and Lactobacillaceae
Genus	Escherichia Shigella, Desulfovibrio, and Streptococcus	Roseburia, Faecalibacterium, Pyramidobacter, Prevotellaceae_UCG-001, and Prevotella_9
Species	Escherichia coli
Characteristics of intestinal microbiota of patients with ESRD
Alpha diversity	66.7% (4/6) studies showed lower richness compared to healthy controls
Beta diversity	83.3% (5/6) studies showed distinct bacterial composition from healthy controls
Alteration of taxa	More abundant	Less abundant
Phylum	Proteobacteria	–
Class	Alphaproteobacteria, Deltaproteobacteria, and Bacilli	Betaproteobacteria
Order	Desulfovibrionales	–
Family	Enterococcaceae, Streptococcaceae, and Desulfovibrionaceae	Prevotellaceae, Ruminococcaceae, and Veillonellaceae
Genus	Streptococcus and Fusobacterium	Prevotella, Coprococcus, Megamonas, and Faecalibacterium
Species		Prevotella spp., Faecalibacterium, and Bifidobacterium

ESRD: end-stage renal disease; CKD: chronic kidney disease.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author.