Diet-microbiota-kidney axis reprogramming: mechanistic insights into microbial metabolite-driven precision nutrition for chronic kidney disease.

Medical nutrition therapy serves as the cornerstone in the management of chronic kidney disease (CKD). While conventional approaches emphasize macronutrient restriction and meal timing adjustments, research highlights the critical mediating role of gut microbiota in translating dietary patterns into physiological effects through metabolite production. Meanwhile, CKD progression is closely associated with dynamic interactions between gut microbiota and their metabolic derivatives. This review introduces the "diet-microbiota- metabolite-kidney axis" framework to elucidate how nutritional components modulate CKD progression via microbial compositional changes and subsequent metabolite alterations. Based on synthesized evidence, this review identifies promising directions for precision nutrition strategies targeting microbial metabolites, including artificial intelligence-assisted dietary planning, engineered bacterial therapies, and metabolite analog development. However, significant interindividual variability in host genetics and baseline microbiota composition necessitates overcoming heterogeneity challenges in nutritional interventions. Consequently, the precise modulation of individualized diet-microbiota-metabolite interactions represents a critical research direction to be prioritized in CKD management.