{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:30:58Z","timestamp":1787923858345,"version":"build-2784847793"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Chronic kidney disease-associated pruritus (CKD-aP) is a common and burdensome complication in patients receiving maintenance hemodialysis (MHD), but its pathogenesis remains incompletely understood. This study aimed to characterize gut microbial differences between MHD patients with active CKD-aP and those without active pruritus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center cross-sectional study, 89 patients receiving MHD were enrolled, including 45 with active CKD-aP (HDUP) and 44 without active pruritus (HDNUP). Fecal samples were analyzed using 16S rRNA gene sequencing. Microbial diversity, taxonomic composition, differentially abundant taxa, and predicted functional profiles were compared between groups. Multivariable association analysis was performed using MaAsLin2 at the phylum, class, order, family, genus, and species levels, with adjustment for age, sex, post-dialysis dry weight, dialysis vintage, the presence of diabetes mellitus, and a documented history of hyperphosphataemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Alpha-diversity indices did not differ significantly between groups. Bray\u2013Curtis-based analysis of similarities showed no difference in overall community structure (R = \u22120.00463, p = 0.5882), whereas unweighted UniFrac-based analysis detected a statistically significant but very small difference (R\u00a0=\u00a00.03449, p = 0.0183). Fourteen genera showed nominal differences in univariable analyses. After multivariable adjustment and false-discovery-rate (FDR) correction, significant associations were identified only at the family and order levels.\n                      <jats:italic>Parasutterella<\/jats:italic>\n                      showed a nominal genus-level association but did not remain statistically significant after FDR correction. LEfSe identified 31 candidate differentially enriched taxonomic features. PICRUSt2 analysis suggested nominal differences in six predicted pathways, including higher predicted protein digestion and absorption in HDNUP and higher predicted RIG-I-like receptor signaling and ether lipid metabolism in HDUP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Active CKD-aP was associated with selective differences in gut microbial relative abundance rather than broad alterations in microbial richness, diversity, or dominant community structure.\n                      <jats:italic>Parasutterella<\/jats:italic>\n                      showed a nominal genus-level association with the absence of active pruritus, although this association did not remain statistically significant after FDR correction. Other taxonomic and predicted functional findings were exploratory and require validation in longitudinal, multicenter studies incorporating absolute microbial quantification and metabolomic analyses.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1917432","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:53:44Z","timestamp":1787921624000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Alterations in gut microbiota among maintenance hemodialysis patients with CKD-associated pruritus: a cross-sectional comparative study of two cohorts"],"prefix":"10.3389","volume":"16","author":[{"given":"Min","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuqing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiarui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengqi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Xingqiao Street Community Health Service Center","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YanQin","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenggui","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyan","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Sichuan Second Hospital of Traditional Chinese Medicine","place":["Chengdu, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Hangzhou Xihu District Zhuantang Street Community Health Service Centre","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Tianshui Wulin Street Community Health Care Centre","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riyang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Hangzhou Traditional Chinese Medicine Hospital of Zhejiang Chinese Medical University","place":["Hangzhou, Zhejiang, China"]},{"name":"Key Laboratory of Kidney Disease Prevention and Control Technology","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1126\/science.aan4526","article-title":"Ectopic colonization of oral bacteria in the intestine drives T(H)1 cell induction and inflammation","volume":"358","author":"Atarashi","year":"2017","journal-title":"Science"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/itx.0000000000000076","article-title":"Chronic kidney disease and itch","volume":"9","author":"Azimi","year":"2024","journal-title":"Itch (Phila)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0246765","article-title":"Metabolomic analysis of uremic pruritus in patients on hemodialysis","volume":"16","author":"Bolanos","year":"2021","journal-title":"PloS One"},{"key":"B4","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1038\/s41587-020-0548-6","article-title":"PICRUSt2 for prediction of metagenome functions","volume":"38","author":"Douglas","year":"2020","journal-title":"Nat. Biotechnol."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.20944\/preprints202408.0153.v1","article-title":"The role of the gut microbiota in complications among hemodialysis patients","volume":"12","author":"Du","year":"2024","journal-title":"Microorganisms"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1038\/s41396-019-0364-5","article-title":"Defining the role of Parasutterella, a previously uncharacterized member of the core gut microbiota","volume":"13","author":"Ju","year":"2019","journal-title":"ISME J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1111\/hdi.12163","article-title":"Pruritus in hemodialysis patients: Results from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS)","volume":"18","author":"Kimata","year":"2014","journal-title":"Hemodial Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1016\/j.jid.2025.06.640","article-title":"Gut microbial signatures associated with uremic pruritus in hemodialysis patients","volume":"58","author":"Ko","year":"2025","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"B9","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1007\/s00253-025-13641-9","article-title":"Phosphoserine phosphatase B facilitates indole metabolism to indole-3-lactic acid","volume":"109","author":"Konishi","year":"2025","journal-title":"Appl. Microbiol. Biotechnol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1128\/CMR.00104-14","article-title":"Actinomyces and related organisms in human infections","volume":"28","author":"Kononen","year":"2015","journal-title":"Clin. Microbiol. Rev."},{"key":"B11","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.kisu.2021.11.003","article-title":"Epidemiology of chronic kidney disease: an update 2022","volume":"12","author":"Kovesdy","year":"2022","journal-title":"Kidney Int. Suppl (2011)"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.carres.2020.107962","article-title":"Biochemical characterization of the endo-\u03b1-N-acetylgalactosaminidase pool of the human gut symbiont Tyzzerella nexilis","volume":"490","author":"Kulinich","year":"2020","journal-title":"Carbohydr Res."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1298432","article-title":"Gut microbiota associations with chronic kidney disease: insights into nutritional and inflammatory parameters","volume":"15","author":"Lazarevic","year":"2024","journal-title":"Front. Microbiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.3892\/ijmm.2020.4495","article-title":"Lactobacillus salivarius BP121 prevents cisplatin\u2011induced acute kidney injury by inhibition of uremic toxins such as indoxyl sulfate and p\u2011cresol sulfate via alleviating dysbiosis","volume":"45","author":"Lee","year":"2020","journal-title":"Int. J. Mol. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.28996\/2618-9801-2020-3-271-292","article-title":"Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference","volume":"97","author":"Levey","year":"2020","journal-title":"Kidney Int."},{"key":"B16","doi-asserted-by":"publisher","first-page":"7569","DOI":"10.1007\/s10787-025-02044-x","article-title":"Gut microbiome-targeted therapeutics for chronic kidney disease: comparative efficacy of probiotic and microbial preparations","volume":"33","author":"Li","year":"2025","journal-title":"Inflammopharmacology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"3755","DOI":"10.1007\/s00394-020-02207-2","article-title":"Effect of probiotics on the intestinal microbiota of hemodialysis patients: a randomized trial","volume":"59","author":"Liu","year":"2020","journal-title":"Eur. J. Nutr."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.579386","article-title":"The effects of hemodialysis and peritoneal dialysis on the gut microbiota of end-stage renal disease patients, and the relationship between gut microbiota and patient prognoses","volume":"11","author":"Luo","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10194456","article-title":"Effects of probiotics, prebiotics, and synbiotics on uremic toxins, inflammation, and oxidative stress in hemodialysis patients: a systematic review and meta-analysis of randomized controlled trials","volume":"10","author":"Nguyen","year":"2021","journal-title":"J. Clin. Med."},{"key":"B20","article-title":"Uremic pruritus evaluation and treatment","volume-title":"statpearls","author":"Osakwe","year":"2026"},{"key":"B21","doi-asserted-by":"publisher","first-page":"3495","DOI":"10.1093\/ndt\/gfl461","article-title":"Pruritus in haemodialysis patients: International results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"21","author":"Pisoni","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"B22","doi-asserted-by":"publisher","first-page":"2000","DOI":"10.2215\/cjn.03280317","article-title":"International comparisons of prevalence, awareness, and treatment of pruritus in people on hemodialysis","volume":"12","author":"Rayner","year":"2017","journal-title":"Clin. J. Am. Soc Nephrol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/20543581241238808","article-title":"Pathways for diagnosing and treating CKD-associated pruritus: a narrative review","volume":"11","author":"Rigatto","year":"2024","journal-title":"Can. J. Kidney Health Dis."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1096\/fj.202100126R","article-title":"Holdemanella biformis improves glucose tolerance and regulates GLP-1 signaling in obese mice","volume":"35","author":"Roman\u00ed-Perez","year":"2021","journal-title":"FASEB J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"339","DOI":"10.2147\/ijnrd.s499798","article-title":"Identification and management of CKD-associated pruritus: current insights","volume":"17","author":"Skrzypczak","year":"2024","journal-title":"Int. J. Nephrol Renovasc Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1159\/000514550","article-title":"Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy","volume":"52","author":"Thurlow","year":"2021","journal-title":"Am. J. Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"183","DOI":"10.2147\/idr.s39601","article-title":"Actinomycosis: etiology, clinical features, diagnosis, treatment, and management","volume":"7","author":"Valour","year":"2014","journal-title":"Infect. Drug Resist."},{"key":"B28","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1681\/asn.2007121377","article-title":"A bench to bedside view of uremic toxins","volume":"19","author":"Vanholder","year":"2008","journal-title":"J. Am. Soc Nephrol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1080\/19490976.2024.2347728","article-title":"Human gut-associated Bifidobacterium species salvage exogenous indole, a uremic toxin precursor, to synthesize indole-3-lactic acid via tryptophan","volume":"16","author":"Yong","year":"2024","journal-title":"Gut Microbes"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1111\/ijd.17254","article-title":"Skin barrier: new therapeutic targets for chronic kidney disease-associated pruritus - a narrative review","volume":"63","author":"Zhai","year":"2024","journal-title":"Int. J. Dermatol."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1464338","article-title":"Cutaneous adaptive immunity and uraemia: a narrative review","volume":"15","author":"Zibandeh","year":"2024","journal-title":"Front. Immunol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1917432\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T12:53:45Z","timestamp":1787921625000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1917432\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":31,"alternative-id":["10.3389\/fcimb.2026.1917432"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1917432","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1917432"}}