End-stage renal disease Original paper
Researched by:
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Dr. Umar
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Dr. Umar
Read MoreClinical Pharmacist and Clinical Pharmacy Master’s candidate focused on antibiotic stewardship, AI-driven pharmacy practice, and research that strengthens safe and effective medication use. Experience spans digital health research with Bloomsbury Health (London), pharmacovigilance in patient support programs, and behavioral approaches to mental health care. Published work includes studies on antibiotic use and awareness, AI applications in medicine, postpartum depression management, and patient safety reporting. Developer of an AI-based clinical decision support system designed to enhance antimicrobial stewardship and optimize therapeutic outcomes.
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Dr. Umar
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Researched by:
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Dr. Umar
ID
Dr. Umar
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Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Dr. Umar
What was reviewed?
End-stage renal disease microbiome is framed in this StatPearls narrative review as the clinical endpoint of chronic kidney disease, integrating guideline-based staging, epidemiology, complications, and management. The chapter summarizes KDIGO criteria, registry data on ESRD burden, and guidance on renal replacement preparation. Although the review does not profile gut or oral microbial taxa, it highlights metabolic, immune, and barrier disturbances—uremia, acidosis, mineral and bone disorder, anemia, fluid overload, and cardiovascular disease that tightly couple to dysbiosis in current nephrology research. This makes the article a mechanistic scaffold for mapping microbiome signatures onto the CKD–ESRD continuum and for interpreting microbial associations in the context of GFR thresholds, albuminuria, and treatment exposures such as dialysis modality, phosphate and potassium binders, and sodium–glucose cotransporter-2 inhibitors.
Who was reviewed?
The population implicitly reviewed comprises adults and older patients with chronic kidney disease progressing to ESRD, with breakdowns by race, sex, and age drawn largely from registry and cohort data. The review emphasizes disproportionate ESRD risk in Black, Hispanic, Indigenous, and other minoritized populations, a higher incidence in males, and the sharp rise in CKD prevalence after age 60. For microbiome-focused clinicians, these gradients intersect with diet, diabetes, and other cardiometabolic diseases, medication exposure including NSAIDs and other nephrotoxins, and social determinants, all of which shape microbial communities and may confound or modify microbiome–ESRD signatures.
Most important findings
Key findings relevant to microbiome work cluster around pathophysiologic domains rather than specific organisms. Progressive nephron loss and hyperfiltration injury lead to uremic toxin accumulation, metabolic acidosis, and electrolyte derangements, a context in which gut-derived solutes such as indoxyl sulfate and p-cresyl sulfate are known to rise and correlate with cardiovascular risk. CKD–mineral and bone disorder, characterized by hyperphosphatemia, altered FGF23–Klotho signaling, and secondary hyperparathyroidism, is strongly influenced by dietary phosphate load and binder use, both of which remodel gut ecology. Anemia, chronic inflammation, and infection burden in ESRD are linked to barrier dysfunction and endotoxemia, while management strategies such as potassium and protein restriction, plant-forward diets, and SGLT2 inhibitors further perturb microbial metabolites.
| Domain relevant to microbiome work | ESRD-related feature summarized in review |
|---|---|
| Metabolism and uremic toxins | ESRD-related feature summarized in the review |
| Bone–mineral–vascular axis | Hyperphosphatemia, altered FGF23–Klotho axis, vascular calcification, and vitamin D deficiency interact with diet and phosphate binders. |
| Immunity, barrier, and anemia | Chronic inflammation, infection risk, anemia of CKD, and malnutrition connect to gut barrier injury and dysbiosis-related endotoxemia. |
| Dialysis and replacement therapy | Modality choice and timing shape diet, medications, and microbial exposure across the ESRD trajectory. |
Key implications
Clinically, the review underscores that early CKD detection, ACEI/ARB use for proteinuria, tight blood pressure and glycemic control, and planned vascular access and transplant evaluation influence survival and hospitalization. For microbiome translation, these levers define exposure windows and effect modifiers when associating microbial signatures with ESRD onset or complications. Integrating standard CKD staging and laboratory thresholds from this review into microbiome study design supports movement from descriptive dysbiosis toward actionable risk stratification, tailored diet and binder regimens, and microbially informed timing and choice of renal replacement therapy.
Citation
Rout P, Aslam A. End-stage renal disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jun 22–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499861/
Chronic Kidney Disease (CKD)
Dysbiosis in chronic kidney disease (CKD) reflects a shift toward reduced beneficial taxa and increased pathogenic, uremic toxin-producing species, driven by a bidirectional interaction in which the uremic environment disrupts microbial composition and dysbiotic metabolites accelerate renal deterioration.