{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:29:22Z","timestamp":1793676562779,"version":"4.5.1"},"reference-count":178,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T00:00:00Z","timestamp":1752537600000},"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. Med."],"abstract":"<jats:p>\n                    The escalating global burden of end-stage renal disease (ESRD), driven by aging populations and rising metabolic comorbidities, underscores the urgent need for innovative therapeutic strategies. Emerging evidence highlights the gut microbiome as a pivotal modulator of renal pathophysiology through the gut-kidney axis, with microbial dysbiosis exacerbating gut microbial metabolites (e.g., uremic toxins), systemic inflammation, and multi-organ damage. This narrative review explores the divergent impacts of kidney replacement therapies (KRT)\u2014hemodialysis (HD) and peritoneal dialysis (PD)\u2014on gut microbiota dynamics: HD is associated with Firmicutes and Proteobacteria enrichment, reduced butyrate-producing taxa (e.g.,\n                    <jats:italic>Faecalibacterium<\/jats:italic>\n                    ,\n                    <jats:italic>Roseburia<\/jats:italic>\n                    ), and systemic microbial translocation; whereas PD-driven glucose absorption and iron supplementation foster pathogenic proliferation (e.g.,\n                    <jats:italic>Enterobacteriaceae<\/jats:italic>\n                    ) and impair short-chain fatty acid (SCFA) metabolism. Current interventions, including probiotics, prebiotics, plant-based diets (PBDs), and fecal microbiota transplantation (FMT), demonstrate potential in mitigating dysbiosis and uremic toxin accumulation. PBDs reduce inflammatory markers (IL-6, CRP) and lower all-cause mortality risk by 24% in PD patients; synbiotics (e.g.,\n                    <jats:italic>Lactobacillus casei<\/jats:italic>\n                    + galactooligosaccharides) reduce serum p-cresyl sulfate by 20% in HD patients; and FMT increases levels of short-chain fatty acids (propionate, butyrate) and lowers trimethylamine N-oxide (TMAO) concentrations in streptozotocin-induced diabetic nephropathy mouse models. However, clinical translation remains challenged by small sample sizes, heterogeneous outcomes, and a lack of hard endpoints. Future research must prioritize standardized protocols, personalized microbial profiling, and synergistic integration of dietary and microbiome-targeted therapies. Bridging mechanistic insights with clinical validation will advance precision medicine in ESRD management, offering transformative potential for patients burdened by this therapeutic impasse.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2025.1620247","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T05:25:25Z","timestamp":1752557125000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":30,"title":["Gut microbiome remodeling in chronic kidney disease: implications of kidney replacement therapies and therapeutic interventions"],"prefix":"10.3389","volume":"12","author":[{"given":"Qianwei","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yucheng","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhicheng","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,15]]},"reference":[{"key":"B1","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":"B2","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1053\/j.semvascsurg.2021.02.010","article-title":"Epidemiology of end-stage kidney disease.","volume":"34","author":"Gupta","year":"2021","journal-title":"Semin Vasc Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.chest.2018.09.004","article-title":"Continuous renal replacement therapy: Who. 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