At first glance, it appears that chronic kidney disease itself alters the intestinal flora. After careful consideration however, this isn’t the most likely cause of what was observed by these researchers. Someone with chronic kidney disease would have had multiple and at times non-stop rounds of antibiotics during the course of their disease and treatment over the years. Even one course of antibiotics will greatly alter the composition of the intestinal flora. A 5- or 7-day course of antibiotics will destroy all of the bacterial flora in the intestinal tract and most everywhere else in the body. The bacterial flora in most cases will take a year to come back and some species will never return without holistic intervention. This type of change is what the researchers were observing.
Yes, the nutrients that are available to the bacteria can shift the make-up of the intestinal flora to an extent, but antibiotics will utterly destroy it and create antibiotic resistant species that place patients at risk.
Chronic kidney disease changes the composition of intestinal bacterial microbes that normally play a crucial role in staving off disease-causing pathogens and maintaining micronutrient balance, according to UC Irvine researchers.
This profound alteration of the gut microbial population may contribute to the production of uremic toxins, systemic and local inflammation, and nutritional abnormalities present in patients with advanced renal disease, they said.
Study leader Dr. N.D. Vaziri of the UCI School of Medicine’s Division of Nephrology & Hypertension noted that consumption of high-fiber foods and better control of uremia — a disease common in kidney failure — by diet and dialysis may improve the composition of gut microbes and the well-being of patients.
The researchers studied microbial DNA extracted from the stool samples of a group of renal failure patients and healthy control individuals. They found marked differences in the abundance of some 190 types of bacteria in the gut microbiome of those with kidney disease — and confirmed the results in a concurrent study of rats with and without chronic kidney disease.
Vaziri explained that nitrogen-rich waste products — particularly urea and uric acid, which are usually excreted by the kidneys — accumulate in the body fluids of patients with renal failure. This leads to the massive release of these waste products in the gastrointestinal tract, supporting the growth and dominance of microbial species that can utilize these compounds.
The impact of this flooding of the gut by nitrogenous waste products in patients with advanced kidney disease, Vaziri added, is compounded by dietary restrictions on fruits and vegetables, which contain the indigestible fibers that favorable gut microbes feed on. This is because fruits and vegetables contain large amounts of potassium, a mineral normally excreted by the kidneys. In cases of renal failure, potassium levels are high, increasing the risk of cardiac arrest.
One solution, Vaziri said, is to provide longer, more frequent dialysis treatments. This would let more potassium be removed by dialysis and allow for more potassium in the diet. Alternatively, packaged fiber foods that do not contain potassium could be used as a dietary supplement.
The work adds to a growing body of evidence pointing to the role of gut bacteria in disease and health. Recent research by other groups has identified changes in the composition of intestinal microbial flora in people with diabetes, colorectal cancer, obesity and inflammatory bowel disease, among other conditions.
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