Gut microbiota in patients receiving dialysis: Mechanisms, complications and the road to personalized microbiome‑based care (Review).

Abstract

Gut dysbiosis is increasingly recognized as a potential contributor to poor outcomes in patients receiving dialysis, yet its mechanistic complexity and therapeutic implications remain incompletely understood in clinical practice. The uremic environment, dietary restrictions, polypharmacy and dialysis modality‑specific factors collectively reshape the gut microbial ecology, promoting the overproduction of deleterious metabolites such as indoxyl sulfate, p‑cresyl sulfate and trimethylamine N‑oxide while depleting protective short‑chain fatty acids. These alterations compromise intestinal barrier integrity, fuel systemic inflammation through endotoxemia and NOD‑like receptor family pyrin domain containing 3 inflammasome activation and have been associated with cardiovascular disease, immune dysfunction, peritonitis, protein‑energy wasting and cognitive impairment. Although probiotic, prebiotic, synbiotic and dietary interventions show promise, heterogeneous responses across trials underscore the inadequacy of one‑size‑fits‑all strategies. Multi‑omics profiling has revealed substantial interindividual variability in microbial composition and metabolic capacity, providing a rationale for personalized approaches. The present review synthesizes current evidence on the mechanisms underlying dysbiosis and complications in patients receiving dialysis and proposes a roadmap toward personalized microbiome‑based care to improve clinical outcomes.