Journal Article

Phosphate, Microbiota and CKD

Fernandez-Prado, Raul, Perez-Gomez, Maria Vanessa, Fernandez-Fernandez, Beatriz, Favero, Chiara, Carriazo, Sol, Sanchez-Niño, Maria Dolores, Gomá-Garcés, Elena, Cuarental, Leticia, Ortiz, Alberto

2021

Overview

Phosphate is a key uremic toxin associated with adverse outcomes. As chronic kidney disease (CKD) progresses, the kidney capacity to excrete excess dietary phosphate decreases, triggering compensatory endocrine responses that drive CKD-mineral and bone disorder (CKD-MBD). Eventually, hyperphosphatemia develops, and low phosphate diet and phosphate binders are prescribed. Recent data have identified a potential role of the gut microbiota in mineral bone disorders. Thus, parathyroid hormone (PTH) only caused bone loss in mice whose microbiota was enriched in the Th17 cell-inducing taxa segmented filamentous bacteria. Furthermore, the microbiota was required for PTH to stimulate bone formation and increase bone mass, and this was dependent on bacterial production of the short-chain fatty acid butyrate. We review current knowledge on the relationship between phosphate, microbiota and CKD-MBD. Topics include microbial bioactive compounds of special interest in CKD, the impact of dietary phosphate and phosphate binders on the gut microbiota, the modulation of CKD-MBD by the microbiota and the potential therapeutic use of microbiota to treat CKD-MBD through the clinical translation of concepts from other fields of science such as the optimization of phosphorus utilization and the use of phosphate-accumulating organisms.

• Publisher: MDPI AG,MDPI
• Subject: Adaptation / Aluminum / Animals / bone density / Bone diseases / bone formation / bone resorption / butyrates / Calcification / Chelating Agents - administration & dosage / Chronic Kidney Disease-Mineral and Bone Disorder - immunology / Chronic Kidney Disease-Mineral and Bone Disorder - metabolism / Chronic Kidney Disease-Mineral and Bone Disorder - microbiology / Chronic Kidney Disease-Mineral and Bone Disorder - therapy / Clinical trials / Coronaviruses / COVID-19 / Diet / Disease Models, Animal / Disease Progression / Food additives / Gastrointestinal Microbiome - immunology / Hemodialysis / Holistic Health / Humans / Hyperphosphatemia - immunology / Hyperphosphatemia - metabolism / Hyperphosphatemia - microbiology / Hyperphosphatemia - therapy / intestinal microorganisms / Kidney diseases / kidneys / Magnesium / Mice / Microbiota / Mortality / parathyroid hormone / Parathyroid Hormone - blood / Parathyroid Hormone - metabolism / phosphates / phosphorus / Phosphorus, Dietary - adverse effects / Phosphorus, Dietary - antagonists & inhibitors / Phosphorus, Dietary - blood / Phosphorus, Dietary - metabolism / Probiotics - therapeutic use / Proteins / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - immunology / Renal Insufficiency, Chronic - metabolism / Renal Insufficiency, Chronic - therapy / Review / short chain fatty acids / Th17 Cells - immunology / therapeutics / Toxins