GUT MICROBIOTA AND BLOOD METABOLIC PROFILE IN PATIENTS ON PERITONEAL DIALYSIS

Introduction:

The study of the microbiome: intestinal microbiota and metabolites in patients with CKD, especially on peritoneal dialysis, is of great interest due to the involvement of altered intestinal microflora in the accumulation of uremic toxins and in  the onset of typical complications (cardiovascular diseases, vascular calcification, infections, dialysis peritonitis)the occurrence of characteristic complications (cardiovascular diseases, vascular calcification, infections, dialysis peritonitis). In addition, the use of probiotics can significantly affect the intestinal microflora and metabolites.

The aim of this study was to investigate the features of the intestinal microbiota in patients on peritoneal dialysis and the effect of the treatment with “Normoflorin”, a probiotic drug, on the blood metabolic profile of patients with CKD.

Methods:

In our study we included 60 patients, age 55±16.4 years (32 f/28 m), who received peritoneal dialysis at our nephrology center. Participants were divided into two groups: one group received “Normoflorin” for 1 month (N=38) and the other group did not (N = 22).  We examined standard biochemical analysis in all patients. Fecal samples were collected between June 2023 and March 2024. The intestinal microbiota was analyzed using 16s rRNA sequencing. 1H nuclear magnetic resonance  spectroscopy was utilized to analyze the serum samples, focusing on low-molecular-weight metabolites. We used standard statistical methods.

Results:

Fig.1 shows microorganisms at the phylum, class, order, family and genus level in patients receiving PD. The visual shows that, on average, the prevailing phylum in the samples was Bacillota, and the second largest phylum was Bacterioidota. The presence of Actinomycetota and Proteobacteria was also observed in significant amounts. Bacterioidia of the Bacterioidota phylum and Clostridia and Bacilli of the Bacillota phylum were significant at the class level. A decrease in the alpha diversity of microorganisms correlated with high ferritin levels and the frequency of dialysis peritonitis. There were no significant correlations with age and the studied biochemical parameters. A total of 55 metabolites were identified in serum samples from patients with CKD. The t-test demonstrated statistically significant changes in several metabolites following “Normoflorin” treatment, including sarcosine, fumarate, hypoxanthine, methionine, isobutyrate, ornithine, acetylcholine and pyruvate (Fig. 2). These findings indicate that “Normoflorin” therapy induces specific metabolic alterations in patients with CKD, predominantly impacting amino acid metabolism and, to a lesser extent, glycerophospholipid metabolism and the TCA cycle.

Conclusions:

In patients undergoing peritoneal dialysis, a decrease in microbial alpha diversity was found, correlating with high ferritin levels and the incidence of dialysis peritonitis.

The use of «Normoflorin» resulted in an improvement in the metabolic profile.

I have potential conflict of interest to disclose.
This research was funded by grant from the Moscow government (research project No. 1803-7/23)

I did not use generative AI and AI-assisted technologies in the writing process.