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As glomerular filtration rate declines, the colon becomes more important as a site of excretion of urea and uric acid, and an increased bacterial proteolytic fermentation alters the gut microbial balance. A diet with limited amounts of fibre, as well as certain medications (eg phosphate binders, iron supplementation, antibiotics) further contribute to changes in gut microbiota composition among CKD patients. At the same time, both vascular calcification and bone disease are common in patients with advanced kidney disease. This narrative review describes emerging evidence on gut dysbiosis, vascular calcification, bone demineralization and their interrelationship termed the \u2018gut\u2010bone\u2010vascular axis\u2019 in progressive CKD. The role of diet, gut microbial metabolites (ie indoxyl sulphate, p\u2010cresyl sulphate, trimethylamine N\u2010oxide (TMAO) and short\u2010chain fatty acids (SCFA)), vitamin K deficiency, inflammatory cytokines and their impact on both bone health and vascular calcification are discussed. This framework may open up novel preventive and therapeutic approaches targeting the microbiome in an attempt to improve cardiovascular and bone health in CKD.<\/jats:p>","DOI":"10.1111\/eci.13588","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T02:04:44Z","timestamp":1620180284000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Interplay between gut microbiota, bone health and vascular calcification in chronic kidney disease"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4450-6869","authenticated-orcid":false,"given":"Fernanda G.","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Department of Nephrology University of Groningen University Medical Center Groningen Groningen the Netherlands"},{"name":"Nutrition Post\u2010Graduation Program Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milene S.","family":"Ormanji","sequence":"additional","affiliation":[{"name":"Nephrology Division Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ita P.","family":"Heilberg","sequence":"additional","affiliation":[{"name":"Nutrition Post\u2010Graduation Program Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Nephrology Division Universidade Federal de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan J. 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