Among strategies for both the prevention and treatment of renal disease, reduction of uremic toxins and bacterial lipopolysaccharides that activates toll-like receptors and improvement in the composition of the microbiome represent valuable and clinically proven approaches. Dietary components-specifically soluble and insoluble prebiotic fibers; phytochemicals such as curcumin, berberine, epigallocatechin gallate, and withanolides that modulate gut immune function and improve detoxification of uremic toxins; and supplemental, clinically tested probiotics-constitute a family of therapeutics that can positively affect patients. In addition, the bidirectional relationship of the microbiome to kidney disease is an important concept in designing a personalized approach to the management of kidney disease, especially with regard to its relationship to cardiovascular disease.
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