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The Link Between Gut Bacteria, TMAO, and Chronic Kidney Disease

The Link Between Gut Bacteria, TMAO, and Chronic Kidney Disease

The prevalence of chronic kidney disease (CKD) is increasing globally, and it is associated with a higher risk of cardiovascular disease (CVD). Recent research from the Cleveland Clinic has established a link between red meat, eggs, high-fat dairy, and a substance produced by gut bacteria called trimethylamine-N-oxide (TMAO).

The elevated levels of TMAO in the blood are associated with an increased risk of heart disease. However, new research indicates that TMAO may also contribute to chronic kidney disease, making it a cause for concern for all, particularly those with high blood pressure or who struggle with healthy eating.

The Link Between TMAO and Chronic Kidney Disease

In a paper published in Circulation Research, Dr. Stanley Hazen and Dr. Wilson Tang of the Cleveland Clinic reported that patients with chronic kidney disease had higher blood levels of TMAO. Patients with higher TMAO levels were at a higher risk of death, regardless of their kidney function.

The researchers also discovered that chronic exposure to diets that raise TMAO in the blood can cause and worsen kidney damage in animals. The results of this research may explain why patients with chronic kidney disease die mainly from heart disease, despite traditional risk factors.

The Connection Between CKD and CVD

Chronic kidney disease occurs when the kidneys are no longer able to filter waste products and excess fluid from the body, causing toxic substances to build up in the blood. This build-up damages the kidneys and further exacerbates the problem. Heart disease is the leading cause of death in patients with CKD, and traditional risk factors, such as high blood pressure, do not adequately explain the association between the two diseases.

The Link Between Gut Bacteria, TMAO, and Chronic Kidney Disease
The Link Between Gut Bacteria, TMAO, and Chronic Kidney Disease

TMAO and the Kidneys

TMAO appears to contribute to kidney decline in a vicious cycle, with higher levels of the substance in the blood leading to a higher risk of heart disease and heart failure. The research indicates that TMAO is cleared by the kidneys, and the higher levels of TMAO in patients with CKD may explain the link between CKD and heart disease.

However, it is unclear whether TMAO is a cause or a consequence of CKD, and further research is needed to understand the mechanism behind the association.

Treating CKD

Treatment for CKD varies depending on the stage of the disease, and patients with advanced CKD may require dialysis or a kidney transplant. However, for those with less severe CKD, lifestyle changes such as a healthy diet, exercise, and quitting smoking can help slow the progression of the disease.

Iron injections are also available to help those with CKD, but these treatments are not without risks, and patients should consult with their doctor before considering any treatments.


The link between TMAO and chronic kidney disease adds to the growing body of evidence highlighting the importance of a healthy diet and lifestyle in preventing chronic diseases such as CKD and heart disease. Patients with CKD should work with their healthcare providers to manage their condition and reduce their risk of complications.


  • What causes TMAO levels to increase in the blood?

    TMAO is produced by gut bacteria during the digestion of red meat, eggs, and high-fat dairy.

  • What are the symptoms of chronic kidney disease?

    Early stages of CKD may not have any symptoms, but as the disease progresses, symptoms may include fatigue, swelling, shortness of breath, and high blood pressure.

  • How is chronic kidney disease diagnosed?

    CKD is usually diagnosed through blood and urine tests that measure kidney function.

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