Authors: (including presenting author): :
Zoe SY Tsang, SK Yuen
Affiliation: :
Renal Team, Caritas Medical Centre
Keyword 2: :
Chronic kidney disease
Introduction: :
Chronic kidney disease (CKD) accounted for 2-3% of total healthcare expenditure and is disproportionally costly to treat (JADE registry: ~USD2990/person/year for diabetes vs USD14774 on end-stage kidney disease (ESKD) occurrence year and USD10020/year on ESKD managed by dialysis). Research postulated an altered gut-kidney axis to exacerbate CKD in a vicious cycle. Nevertheless, confounders such as ethnicity, geography and dietary habits limited extrapolation of overseas data to Hong Kong. On the other hand, self-funded treatment with probiotics or prebiotics that alter CKD patient’s microbiota might have complementary roles in multifaceted healthcare and was in alignment with personalised medicine and patient empowerment.
Objectives: :
(1) describe local microbial phyla across various CKD stages (2) determine Firmicutes-Bacteroidetes (F/B) ratio in patients with CKD (3) explore simple microbiota parameters that might be associated with short-term renal outcomes and mortality
Methodology: :
From 1 July, 2023 to 31 December, 2024, a total of 146 local Chinese adults with CKD stages 1-5 were recruited in Caritas Medical Centre. Demographics, comorbidities, medications, laboratory parameters, inflammatory markers, uremic toxins and microbiota profile were described. Exploratory analyses included correlating baseline microbiota parameters with adverse renal outcomes.
Result & Outcome: :
Out of the 146 participants (58.2% male; mean age 62.66 years; mean serum creatinine 187.45 µmol/L), at least 92% had Firmicutes as their dominant phylum (mean abundance 70%), Bacteroidetes 10%, median F/B ratio 8.56. After a median follow-up of 9.77 months, eight reached ESKD requiring dialysis and one died of fluid overload. Seven patients developed estimated glomerular filtration rate drop by 50% (eGFR0.5), 27 patients had eGFR drop by 20% (eGFR0.2), while 69 patients had eGFR drop by 3mL/min/1.73m2/year (Rapid3) by the end of study dated 30 April 2025. Lowest F/B ratio quartile, or the concomitant Firmicutes prevalence of ≥ 75% and Bacteroidetes prevalence of ≥ 8% were associated with worse renal outcomes. In conclusion, we described microbiota profiles of CKD patients in Hong Kong and postulated specific microbial profile carried inferior renal prognosis. Our ongoing analysis at the genera-level, full inflammatory markers and metabolomes profile would lay the foundation of interventional studies (e.g. probiotics) that potentially reshape patients’ microbiota and improve kidney survivals.
