ArticleBMC gastroenterology2026
Short-chain fatty acids of intestinal origin attenuate protein-bound uremic toxins in patients with chronic kidney disease by protecting the intestinal barrier: a pooled analysis of multiple studies with individualized intervention strategies.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPatients with chronic kidney disease (CKD) present a disordered short-chain fatty acid (SCFA)-intestinal barrier-protein-bound uremic toxin (PBUT) axis, while clinical guidelines lack strategies for PBUT source reduction. This study explored the regulatory effects of SCFAs to support individualized interventions for CKD patients.
methodsA non-individual participant data pooled analysis was conducted on 4 studies (3 cross-sectional, 1 randomized controlled trial) including 320 CKD patients and 53 healthy controls. Correlation, mediation, subgroup, and dose-response analyses were performed to assess SCFAs, intestinal barrier, PBUTs, and renal function.
resultsSCFA-producing bacteria were significantly reduced in CKD patients (P < 0.001). Butyric acid was negatively correlated with p-cresyl sulfate (rₛ=-0.423, P < 0.001). The intestinal barrier mediated 37.2% of the SCFA-PBUT regulatory effect. Synbiotic and low-protein high-fiber diets optimally reduced PBUTs, with greater benefits in CKD stages 4-5 (P interaction = 0.031). High-fiber diets were safe in non-dialysis patients.
conclusionsSCFAs attenuate PBUT accumulation by protecting the intestinal barrier, which may improve CKD prognosis. Synbiotic and low-protein high-fiber diets are effective interventions, especially for advanced CKD.
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