The possible role of physical activity in the modulation of gut microbiota in chronic kidney disease and its impact on cardiovascular risk: a narrative review

Chronic degenerative non-communicablediseases (CDNCDs), in particularchronic kidney disease, induce gut microbiota(GM) dysbiosis, which, in turn, worsens theprogression of CDNCDs and patients’ quality oflife. We analyzed literature studies to discussthe possible positive and beneficial impact ofphysical activity on GM composition and CVrisk in CKD patients. Regular physical activityseems to be able to positively modulate theGM, reducing the systemic inflammation andconsequently the production of uremic gut-derivedtoxins, which are directly correlated withthe increase of cardiovascular risk. In particular,the accumulation of indoxyl sulphate (IS)seems to be able to induce vascular calcifications,vascular stiffness and cardiac calcifications,while p-Cresyl sulphate (p-CS) seems tobe able to exert a cardiotoxic action throughmetabolic pathways, capable of inducing oxidativestress. In addition, trimethylamine N-oxide(TMAO) can alter lipid metabolism, inducingthe production of foam cells and causing an acceleratedatherosclerosis process. In this context,a regular physical activity program seemsto represent an adjuvant non-pharmacologicalapproach for the clinical management of CKDpatients.