Kidney Week

Abstract: SA-PO0090

Gut Microbiome Signatures Associated with ESKD in Korean Patients

Session Information

• Artificial Intelligence: Kidney Imaging, Pathology, and Precision Phenotyping
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Artificial Intelligence, Digital Health, and Data Science

• 300 Artificial Intelligence, Digital Health, and Data Science

Authors

• Fu, Minjie, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Minjie Fu, PhD

• Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Hajeong Lee, MD, PhD

Background

Identifying novel biomarkers for end-stage kidney disease (ESKD) is important for improving diagnosis and therapeutic interventions. Although gut microbial dysbiosis has been implicated in ESKD, integrated taxonomic and functional profiling in well-characterized cohorts using shot-gun metagenomic sequencing remains limited.

Methods

A total of 151 Korean ESKD patients prior to kidney transplantation and 57 healthy donors were enrolled for this study. Clinical parameters were compared between the two groups. Stool samples were collected and processed for shotgun metagenomic sequencing to assess gut microbiome taxonomic composition, functional pathways and microbial ecological networks. Multivariable models adjusting for relevant clinical covariates were applied, and false discovery rate (FDR) correction was used to account for multiple testing.

Results

Significant differences in baseline characteristics were observed between ESKD patients (e.g., 58.94% male; age 52.00 [41.50–58.50] years; BUN, 52.08 ± 17.86; eGFR, 7.39 ± 3.15) and healthy donors (e.g., 40.35% male; age 49.00 [38.00–56.00] years; BUN, 12.88 ± 3.48; eGFR, 108.53 ± 9.93). ESKD patients exhibited significant increased alpha diversity, accompanied by enrichment of several low-abundance taxa, including species from Enterocloster, Hungatella, and Ruthenibacterium. In contrast, taxa including Lachnospira spp. and Bifidobacterium spp., were significantly depleted in ESKD patients. Although several taxa showed significant associations with BUN levels and hypertension, these associations were largely independent of age, sex, BMI, and dialysis duration. Ecological shifts were observed in ESKD compared to healthy controls, characterized by increased significant correlations and higher node degree distributions. Functional profiling analysis demonstrated that enrichment of metabolic pathways, such as sulfide metabolism and tryptophan degradation, whereas pathways involved in vitamin B₂, histidine and lysine biosynthesis were significantly reduced in ESKD patients.

Conclusion

ESKD is associated with coordinated taxonomic and functional reprogramming of the gut microbiome, characterized by enhanced sulfur metabolism, amino acid and carbohydrate metabolism and depletion of vitamin biosynthesis capacity. These findings provide potential targets for future biomarker and therapeutic studies in ESKD patients prior to kidney transplantation.

Funding

• Government Support – Non-U.S.