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Gut microbiota in chronic kidney disease-mineral and bone disorder: shared mechanisms, disease-specific signatures, and therapeutic prospects

Year: 2026

Type: article

Abstract: Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a systemic syndrome characterized by mineral metabolism disorders and impaired bone homeostasis. Recent studies have indicated that gut microbiota dysbiosis is a key regulatory factor driving the development and progression of this disease. This review systematically summarizes the mechanisms by which gut microbiota acts in CKD-MBD through the "gut-kidney-bone axis": dysbiosis drives chronic low-grade inflammation by impairing the intestinal barrier and promoting endotoxin translocation; alterations in its metabolites (e.g., reduced short-chain fatty acids, accumulation of uremic toxins) and dysregulation of endocrine pathways (e.g., FGF23-Klotho axis, PTH) collectively exacerbate renal injury and abnormal bone metabolism. Additionally, in diseases such as CKD, rheumatoid arthritis (RA), osteoarthritis (OA), and osteoporosis (OP), gut microbiota exhibits the coexistence of "shared dysbiosis" and "disease-specific characteristics," which collectively contribute to chronic inflammation and metabolic disorders. Interventional strategies targeting gut microbiota have demonstrated the potential to regulate this axis and improve bone health, marking that the management of metabolic bone diseases and chronic kidney disease is entering the "era of microbiome medicine." This review aims to provide new insights into understanding the comorbidity mechanisms of the aforementioned diseases and lay a theoretical foundation for the development of microbiota-targeted therapeutic strategies.

Source: Frontiers in Endocrinology

DOI: 10.3389/fendo.2026.1802845

Authors: Qianwei Wang, Zhicheng Zhou, Liang Pang, Yuchen Du, Xiaolong Li, Lijuan Dai