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Abstract: PO2052

Gut Dysbiosis and Mortality in Hemodialysis Patients

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Author

  • Lin, Ting-yun, Taipei Tzu Chi Hospital, Taipei, Taiwan
Background

Persistent inflammation plays a pathogenic role in CKD-associated protein-energy wasting, cardiovascular disease, and mortality. Gut dysbiosis, characterized by decreased microbial diversity, promotes inflammation. The gut microbiota is markedly altered in patients with ESKD. Therefore, we aimed to determine the relationship between gut dysbiosis and mortality in an ESKD cohort.

Methods

In an observational study, we examined the associations between microbial diversity and mortality in ESKD patients undergoing maintenance hemodialysis (n=109) using Cox proportional hazards models. The gut microbiota was assessed by 16S rRNA sequencing. Microbial diversity was calculated using the Simpson index. Participants were stratified into higher- (above the median) and lower-diversity (below the median) groups and were followed up for a median of 2.1 years. Next, in a matched case-control study, we compared the microbial composition between nonsurvivors and survivors.

Results

Kaplan-Meier analyses revealed a significant association between higher diversity and a lower risk of death (P=0.015). After adjustment for patient characteristics and comorbidities, the risk of death among patients with higher diversity was 74% lower than that among patients with lower diversity (hazard ratio, 0.26; 95% CI, 0.07 to 0.95). Nonsurvivors and survivors were matched 1:4 for age and sex. We observed significantly lower values of microbial diversity and higher levels of proinflammatory cytokines (IL-6 and TNF-α) among nonsurvivors (n=14) than survivors (n=56). Notably, the relative abundance of Succinivibrio and Anaerostipes, two short-chain fatty acid-producing bacteria, was reduced in nonsurvivors compared with survivors.

Conclusion

A unique gut microbial composition is associated with an increased risk of mortality in patients with ESKD and may be used to identify subjects with a poor prognosis. Our findings need to be validated in a larger independent cohort.

Kaplan–Meier analysis curves. Hemodialysis patients were stratified by the median of the Simpson index to assess the unadjusted risks for all-cause mortality.

Funding

  • Private Foundation Support