Gut microbial shifts along the DM-DKD axis correlate with adverse glycemic and renal phenotypes, as well as functional characteristics associated with inflammation and barrier injury, suggesting that microbially driven metabolic and structural pathways represent potential targets for mitigating the progression of DKD.
Key Findings
Results
Alpha-diversity showed no significant difference between DKD and healthy controls, but Simpson's index was higher in DKD than in DM.
Shotgun metagenomic sequencing was performed on fecal samples from 55 healthy participants, 47 DM patients, and 38 DKD patients.
Overall alpha-diversity showed no significantly difference between DKD and healthy controls.
Simpson's index was higher in DKD than in DM (p < 0.05).
Results
Beta-diversity differed between DKD and healthy controls but not between DKD and DM groups.
There was a significant difference in beta-diversity between DKD and the healthy control group (p = 0.002).
No significant difference in beta-diversity was observed between the DKD and DM groups.
Analysis was conducted using shotgun metagenomic sequencing on fecal samples across three groups.
Results
Several bacterial genera were significantly enriched in DM/DKD patients and positively correlated with glycemic and renal indicators.
Bacteria enriched in DM/DKD included Mediterraneibacter, Enterocloster, Shigella, Limosilactobacillus, and Thomasclavelia.
These genera showed positive correlations with glycemic indicators including HbA1c and fasting blood glucose.
These genera also showed positive correlations with renal indicators including BUN and UACR.
Results
Multiple bacterial genera were enriched in healthy controls and negatively correlated with glycemic and renal parameters.
Health-enriched bacteria included Phocaeicola, Faecalibacterium, Lachnospira, Agathobacter, Odoribacter, and Paraprevotella.
These genera were negatively correlated with glycemic indicators (HbA1c, fasting blood glucose) and renal indicators (BUN, UACR).
These findings suggest these bacteria may have protective roles in DM and DKD progression.
Results
Compared to the DM group, the DKD group showed enrichment of functional pathways related to aromatic amino acid biosynthesis, biofilm formation, and lipopolysaccharide biosynthesis.
Enriched pathways in DKD versus DM included aromatic amino acid biosynthesis pathways for phenylalanine, tyrosine, and tryptophan.
Additional enriched pathways in the DKD group included biofilm formation and lipopolysaccharide biosynthesis.
These functional characteristics are associated with inflammation and barrier injury.
Functional pathway analysis was performed using shotgun metagenomic sequencing data.
Yu S, Niu H, Zhang Y, Yu L, Zhang Q, Liu X, et al.. (2026). Characterization of gut microbiota in patients with diabetic kidney disease.. Frontiers in cellular and infection microbiology. https://doi.org/10.3389/fcimb.2026.1713005