Microbiota-targeted interventions in chronic kidney disease: probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and traditional Chinese medicine
7 affiliations
- 1Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- 2Pharmacy Department, Sinopharm Tongmei General Hospital, Datong, China
- 3Institute of Vascular Anomalies, Shanghai TCM-Integrated Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- 4Department of Pharmacy, Kunshan Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
- 5Department of Pharmacy, The People’s Hospital of Wenzhou, Suzhou, China
- 6The Department of Pharmacy, The Second Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
- 7Department of Pharmacy, Quzhou People's Hospital; The Quzhou Affiliated Hospital, Wenzhou Medical University, Quzhou, China
Abstract
Chronic kidney disease (CKD) is tightly associated with gut dysbiosis that fuels uremic toxin buildup, systemic inflammation, and renal fibrosis, yet conventional CKD therapies offer limited disease-modifying choices. This narrative review integrates preclinical and clinical evidence (searched PubMed, Web of Science, Cochrane up to May 31, 2026) for gut-microbiota interventions, probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and traditional Chinese medicine (TCM), and compares their efficacy via network meta-analyses stratified by CKD stages. All microecological agents remodel gut flora, boost short-chain fatty acid producers and strengthen intestinal barriers to cut protein-bound uremic toxins, but eGFR benefits vary by strain, formulation, and disease stage, with most robust effects in non-dialysis CKD (stages 3-4). Dialysis patients gain minimal renal improvements, only mild anti-inflammatory and gastrointestinal relief. Network meta-analyses indicate distinct therapeutic strengths of each regimen, yet indirect cross-study comparisons yield low-to-moderate evidence certainty without direct head-to-head trials. FMT and herbal TCM show promising renoprotective gut-kidney regulatory effects in animal research and small preliminary human cohorts, though large controlled human trials remain absent. Subtype-specific CKD responses (diabetic nephropathy, IgA nephropathy) cannot be universally extrapolated. Despite encouraging mechanistic and early clinical signals, standardized testing, comparative trials and strict safety monitoring for fragile CKD patients are required before routine guideline use of gut-targeted therapies.
Related
- Gut Microbiota Dysbiosis in Advanced Chronic Kidney Disease and Kidney Transplantation: A Narrative Review of Pathophysiological Mechanisms, Implications for Nutritional Status, and Biotic Interventions
- Faecal microbiota transplantation for treatment of chronic urticaria with recurrent abdominal pain and food allergy
- Gut microbiota modulation of gastrointestinal cancers: from dysbiosis signatures to therapeutic interventions
- Microbiota–host crosstalk in ulcerative colitis: mechanistic evidence and translational prospects for traditional Chinese medicine
- Gut-liver axis dysregulation and restoration in decompensated hepatitis B cirrhosis: rationale and research progress of fecal microbiota transplantation
BibTeX
@article{li2026microbiotatargeted,
title = {{Microbiota-targeted interventions in chronic kidney disease: probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and traditional Chinese medicine}},
author = {Liu-Cheng Li and Wen-Hui Cui and Zhi-Hui Zhang and Jing Song and Yao-Yao Xu and Ding-Ge Cai and Yan Guan and Kai-Li Mao},
journal = {Frontiers in Cellular and Infection Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fcimb.2026.1900027},
url = {https://doi.org/10.3389/fcimb.2026.1900027},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Microbiota-targeted interventions in chronic kidney disease: probiotics, prebiotics, synbiotics, fecal microbiota transplantation, and traditional Chinese medicine
AU - Liu-Cheng Li
AU - Wen-Hui Cui
AU - Zhi-Hui Zhang
AU - Jing Song
AU - Yao-Yao Xu
AU - Ding-Ge Cai
AU - Yan Guan
AU - Kai-Li Mao
PY - 2026
DA - 2026/10/13
JO - Frontiers in Cellular and Infection Microbiology
DO - 10.3389/fcimb.2026.1900027
UR - https://doi.org/10.3389/fcimb.2026.1900027
AB - Chronic kidney disease (CKD) is tightly associated with gut dysbiosis that fuels uremic toxin buildup, systemic inflammation, and renal fibrosis, yet conventional CKD therapies offer limited disease-modifying choices. This narrative review integrates preclinical and clinical evidence (searched PubMed, Web of Science, Cochrane up to May 31, 2026) for gut-microbiota interventions, probiotics, prebiotics, synbiotics, fecal microbiota transplantation (FMT), and traditional Chinese medicine (TCM), and compares their efficacy via network meta-analyses stratified by CKD stages. All microecological agents remodel gut flora, boost short-chain fatty acid producers and strengthen intestinal barriers to cut protein-bound uremic toxins, but eGFR benefits vary by strain, formulation, and disease stage, with most robust effects in non-dialysis CKD (stages 3-4). Dialysis patients gain minimal renal improvements, only mild anti-inflammatory and gastrointestinal relief. Network meta-analyses indicate distinct therapeutic strengths of each regimen, yet indirect cross-study comparisons yield low-to-moderate evidence certainty without direct head-to-head trials. FMT and herbal TCM show promising renoprotective gut-kidney regulatory effects in animal research and small preliminary human cohorts, though large controlled human trials remain absent. Subtype-specific CKD responses (diabetic nephropathy, IgA nephropathy) cannot be universally extrapolated. Despite encouraging mechanistic and early clinical signals, standardized testing, comparative trials and strict safety monitoring for fragile CKD patients are required before routine guideline use of gut-targeted therapies.
SN - 2235-2988
ER -