{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:21:33Z","timestamp":1790266893796,"version":"4.1.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"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. Endocrinol."],"abstract":"<jats:p>Chronic kidney disease (CKD) is increasingly recognized as a systemic endocrine\u2013metabolic disorder in which gut dysbiosis acts as a key amplifier of disease progression and complications. This mini-review summarizes current evidence linking alterations in gut microbial composition and function to major endocrine and metabolic derangements in CKD. Dysbiosis promotes the accumulation of gut-derived uremic toxins, including indoxyl sulphate, p-cresyl sulphate, and trimethylamine N-oxide, while reducing beneficial metabolites such as short-chain fatty acids, vitamin K, and protective tryptophan derivatives. Through interconnected pathways involving inflammation, oxidative stress, endothelial injury, immune dysregulation, and disturbed inter-organ signalling, these changes contribute to chronic kidney disease\u2013mineral and bone disorder, vascular calcification, insulin resistance, protein\u2013energy wasting, anaemia, and cognitive dysfunction. We further discuss major controversies, including the context-dependent role of trimethylamine N-oxide, the contested operational definition of \u201cdysbiosis,\u201d and the clinical balance between low-protein dietary strategies and the risk of malnutrition, as well as the role of dietary fibre and whole-diet patterns. Practical diet-related approaches that translate these mechanistic findings into clinical practice are also outlined. Current limitations include incomplete mechanistic validation, limited longitudinal and interventional data, and inadequate integration of multi-omics approaches. Overall, available evidence suggests that gut dysbiosis is not simply a consequence of renal impairment, but a mechanistically relevant and potentially modifiable mediator of endocrine and metabolic complications in CKD. A better understanding of microbiota\u2013metabolite\u2013host interactions may support precision nutrition and microbiota-targeted therapies for risk stratification and treatment in renal endocrinology.<\/jats:p>","DOI":"10.3389\/fendo.2026.1854704","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T10:15:00Z","timestamp":1780049700000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The role of gut dysbiosis in endocrine and metabolic derangements of chronic kidney disease: mechanisms, controversies, and future perspectives"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhiqiang","family":"Ouyang","sequence":"first","affiliation":[{"name":"Department of Radiology, Yan\u2019an Hospital of Kunming City (Yan\u2019an Hospital Affiliated to Kunming Medical University)","place":["Kunming, China"]},{"name":"Key Laboratory of Cardiovascular Disease of Yunnan 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