A.E. KHRULEV¹, I.V. SOLOVYEVA², N.S. KHRULEVA¹, V.N. GRIGORYEVA¹, I.V. BELOVA², A.G. TOCHILINA², D.A. GORYACHEVA¹, E.A. GOLEV¹

¹Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod

²Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology, Nizhny Novgorod 

Contact:

Khrulev A.E. ― PhD (medicine), Associate Professor of the Department of Neurology, Neurosurgery and Medical Genetics

Address: 10/1 Minin and Pozharsky sqr., Nizhny Novgorod, Russian Federation, 603950, tel.: (831) 438-95-67, +7-903-607-24-64, e-mail: alexey_khrulev@mail.ru

Hemodialysis (HD) predisposes patients to develop intestinal microbiocenosis disorders. The greatest attention is paid to two possible mechanisms for the intestinal microbiome changes: dietary features and the regimen of the selected method of extracorporeal detoxification (HD, peritoneal dialysis (PD) or a functioning kidney transplant).

The research object is modern (2013 and later) publications devoted to the intestinal microbiota in HD patients.

The aim is to provide an analytical review containing a comprehensive analysis of data and publications on the relationship between intestinal microbiota and systemic vascular inflammation.

The research method is a critical analysis of the literature data and generalization of the currently available results of the original studies on the intestinal microbiota in HD patients.

More significant violations of the barrier function of the gastrointestinal tract (GIT) are observed in HD patients, a focus of chronic inflammation is formed in the intestinal wall, and the level of systemic endotoxemia increases. Disorders of the intestinal microbiota in patients with end-stage chronic kidney disease (CKD) are characterized by a significant expansion of opportunistic bacterial families, including those producing uremic toxins (indoxyl sulfate (IS) and para-cresyl sulfate (PCS)). An increase in the levels of the latter is associated with an increase in the level of inflammation, oxidative stress, the progression of CKD and a higher risk of cardiovascular diseases (CVD). In this regard, the intestinal microbiota and gastrointestinal tract of dialysis patients can be considered as another source of endotoxemia and a vascular risk factor.

Conclusion. Recognizing the role of impaired intestinal microbiota in the pathogenesis of systemic inflammation in dialysis patients makes intestinal microbiocenosis an attractive therapeutic target. Understanding the mechanisms of HD influence on the intestinal microbiota in patients, timely diagnosis of its disorders, finding out correction methods, selecting personalized diets and the regimen of the drug therapy can increase the efficiency of treatment of dialysis patients, improve their condition, reduce the severity of systemic endotoxemia and comorbid vascular pathology.

Key words: microbiota, hemodialysis, vascular risk, endotoxemia, uremic toxins.

(For citation: Khrulev A.E., Solovyeva I.V., Khruleva N.S., Grigoryeva V.N., Belova I.V., Tochilina A.G., Goryacheva D.A., Golev E.A. Intestinal microbiota as a significant factor of endotoxemia and vascular risk in patients on hemodialysis. Practical medicine. 2019. Vol. 17, №8, P.. 11-16)

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