Gut dysbiosis in kidney injury: therapeutic potential of fecal microbiota transplantation

Chronic kidney disease (CKD) poses a substantial global health burden. The gut-kidney axis has become a critical area of research, given the influence of gut microbiota on the kidney. CKD exhibits a distinct gut dysbiosis signature, comprising an altered microbial architecture divergent from healthy individuals and specific microbial changes that exhibit distinct associations with the degree of renal impairment. Preclinical studies lend support to the therapeutic capacity of fecal microbiota transplantation (FMT) in CKD, demonstrating its efficacy in reshaping gut dysbiosis, rehabilitating the gut barrier, rectifying immune imbalance, and reducing fibrosis. These mechanistic insights are complemented by observations of its synergistic effects when combined with standard therapeutics in other conditions, underscoring its potential to improve human kidney outcomes. This review synthesizes current knowledge on CKD-associated dysbiosis, impaired intestinal barrier, and the therapeutic potential of FMT in mitigating the progression of CKD.