{
  "abstract": "Chronic kidney disease (CKD) is associated with intestinal dysbiosis, barrier dysfunction, uremic toxin accumulation, and systemic inflammation. This narrative review critically evaluates the gut-kidney axis, focusing on the distinction between NLRP3 [Nucleotide-binding Oligomerization Domain (NOD)-like receptor pyrin domain-containing protein 3] inflammasome priming and direct activation. It also examines the diagnostic and prognostic relevance of related biomarkers. Preclinical studies, clinical investigations, systematic reviews, meta-analyses, and relevant clinical trials within the past decade were considered. CKD-associated barrier dysfunction increases exposure to lipopolysaccharides and gut-derived metabolites. Lipopolysaccharide (LPS)-mediated TLR4/NF-κB (Toll-like receptor 4/nuclear factor kappa B) signaling provides well-supported inflammasome priming. Indoxyl sulfate acts predominantly as a priming stimulus, although its effects vary among cell types. Direct NLRP3 activation by p-cresyl sulfate has not been demonstrated. Trimethylamine N-oxide has the strongest experimental evidence for inflammasome activation. Candidate biomarkers include these metabolites, microbial profiles, intestinal permeability markers, and inflammasome-related mediators. However, their interpretation is limited by dependence on renal clearance, assay heterogeneity, absent standardized thresholds, and uncertain added value beyond estimated glomerular filtration rate and urinary albumin-to-creatinine ratio. Interventional studies remain small and predominantly use surrogate endpoints. The gut-toxin-inflammasome axis is mechanistically plausible, but evidence for priming is substantially stronger than that for direct activation. Its biomarkers remain research tools and require assay harmonization, prospective validation, and demonstration of independent clinical value before routine implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Biology and Life Science, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Department of Internal Medicine, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Hemodialysis Department, Arad County Emergency Clinical Hospital, Str. Andrényi Károly nr 2-4, 310037 Arad, Romania.",
    "Internal Medicine Clinic, Arad County Emergency Clinical Hospital, Str. Andrényi Károly nr 2-4, 310037 Arad, Romania.",
    "Department of Intensive Care and Emergency Medicine, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Intensive Care and Emergency Medicine Clinic, Arad County Emergency Clinical Hospital, Str. Andrényi Károly nr 2-4, 310037 Arad, Romania.",
    "Department of Biochemistry, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Department of Urology, MedLife Humanitas Hospital, 400664 Cluj-Napoca, Romania.",
    "Fundamental Discipline, Anatomy, Faculty of Nursing and Health Sciences, \"Iuliu Hațieganu\" University of Medicine and Pharmacy, Victor Babes Street Number 8, 400347 Cluj-Napoca, Romania.",
    "Clinical Laboratory of Medical Analyses, Arad County Emergency Clinical Hospital, Str. Andrényi Károly nr 2-4, 310037 Arad, Romania.",
    "Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Str. Universității nr 1, 410087 Oradea, Romania.",
    "Department of Otorhinolaringology, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Department of Heamatology, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania.",
    "Department of General Surgery, Faculty of Medicine, \"Vasile Goldiș\" Western University of Arad, B-dul Revoluției nr. 94-96, 310025 Arad, Romania."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Imola Donath-Miklos",
      "orcid": "0009-0009-9542-0035"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Oana Știrbu",
      "orcid": "0009-0001-8127-5131"
    },
    {
      "affs": [
        1,
        3
      ],
      "name": "Romana Olivia Popețiu",
      "orcid": "0009-0000-1192-1452"
    },
    {
      "affs": [
        4,
        5
      ],
      "name": "Adrian Silviu Crișan",
      "orcid": "0009-0002-4374-4248"
    },
    {
      "affs": [
        6
      ],
      "name": "Paula Alexandra Vulciu"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Roxana Andra Coman",
      "orcid": "0000-0001-7790-388X"
    },
    {
      "affs": [
        0,
        9
      ],
      "name": "Cecilia Roberta Avram"
    },
    {
      "affs": [
        10
      ],
      "name": "Darius Radu Roman"
    },
    {
      "affs": [
        11
      ],
      "name": "Radmila-Anca Bugari"
    },
    {
      "affs": [
        6,
        11
      ],
      "name": "Dana Zdremțan"
    },
    {
      "affs": [
        0
      ],
      "name": "Maria Orodan"
    },
    {
      "affs": [
        6
      ],
      "name": "Luminița Pilat",
      "orcid": "0009-0000-0163-5698"
    },
    {
      "affs": [
        1,
        3
      ],
      "name": "Larisa Alexandra Rus",
      "orcid": "0009-0004-1281-9862"
    },
    {
      "affs": [
        12
      ],
      "name": "Cristina Georgiana Firu"
    },
    {
      "affs": [
        13
      ],
      "name": "Mihai Cătălin Roșu"
    },
    {
      "affs": [
        1,
        3
      ],
      "name": "Simona Maria Borta",
      "orcid": "0000-0002-2512-2691"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/394pf13yss26d.bib",
  "cited_by": 0,
  "doi": "10.3390/diagnostics16193084",
  "fulltext_url": "https://europepmc.org/articles/PMC13664321",
  "id": "394pf13yss26d",
  "issns": [
    "2075-4418"
  ],
  "landing_url": "https://europepmc.org/article/MED/42882239",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2727|Dialysis and Renal Disease Management"
    ]
  ],
  "openalex": "W7214085089",
  "pdf_url": "https://europepmc.org/articles/PMC13664321?pdf=render",
  "pmcid": "PMC13664321",
  "pmid": "42882239",
  "published": "2026-09-23",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/394pf13yss26d.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:16Z",
      "native_id": "MED:42882239",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42882239"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2727|Dialysis and Renal Disease Management",
      "subfield": "general"
    }
  ],
  "title": "Gut Dysbiosis, Uremic Toxins, and NLRP3 Signaling in Chronic Kidney Disease: From Mechanistic Evidence to Clinical Biomarker Evaluation.",
  "title_text": "Gut Dysbiosis, Uremic Toxins, and NLRP3 Signaling in Chronic Kidney Disease: From Mechanistic Evidence to Clinical Biomarker Evaluation.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:16Z",
  "url": "https://research.draconitic.com/paper/394pf13yss26d",
  "venue": "Diagnostics (Basel, Switzerland)",
  "versions": []
}