Integrative Kidney Institute, بناء المهندسن ساحة المحافظهBuilding Engineers Square Mun, Damascus (2026)

14/09/2026

Most treatments for chronic kidney disease (CKD) are designed to slow progression.

🦠But what if targeting the gut microbiome could help reverse some of the damage already present?🫘

A fascinating new preclinical study investigated TMAO, a metabolite produced through interactions between gut microbes and certain dietary compounds that has been associated with CKD and cardiovascular disease.

Researchers treated mice with established CKD using a compound that selectively blocked microbial TMAO production.

The results were striking:

🦠 Circulating TMAO was nearly eliminated
📈 GFR improved by 39%
🧪 Creatinine, cystatin C, albuminuria, and several uremic toxins decreased
🫘 Kidney fibrosis decreased by 41%

Importantly, treatment began after kidney disease was already established. Rather than simply slowing further deterioration, researchers observed measurable improvement in both kidney function and structural damage.

Why is this exciting?

The gut microbiome is increasingly emerging as an important contributor to kidney disease. This study raises the possibility that manipulating specific microbial pathways could eventually become a new therapeutic approach to CKD.

⚠️ There is an important caveat: this was a mouse study. We do not yet know whether blocking TMAO production will produce similar results in humans, and this compound is not an established CKD treatment.

Still, the findings offer an intriguing glimpse into a future where treating CKD may involve not only protecting the kidneys themselves, but also targeting the gut-kidney axis.

Read the study here [link in bio]

https://journals.lww.com/jasn/abstract/10.1681/asn.0000001171~targeted-inhibition-of-gut-microbial-trimethylamine-n--oxide?redirectionsource=fulltextview

13/09/2026

A new review in Nature Reviews Nephrology explores how changes in cellular metabolism may help drive kidney injury in autoimmune diseases such as lupus nephritis, IgA nephropathy, and ANCA-associated vasculitis.

Immune cells need energy to activate, multiply, produce antibodies, and survive inside inflamed tissue. In autoimmune kidney disease, many of these cells appear to shift toward increased:

🔹 Glycolysis
🔹 Mitochondrial energy production
🔹 Iron-dependent metabolic pathways

But the metabolic changes are not limited to immune cells.

Kidney cells themselves, including mesangial and glomerular endothelial cells, may also alter their metabolism in response to inflammation. These changes can potentially make the kidney environment even more supportive of ongoing immune injury.

The result may be a vicious cycle:

Immune activation changes metabolism → altered metabolism promotes inflammation → kidney injury further reshapes the local metabolic environment.

The authors also highlight ferroptosis, a form of iron-dependent cell death, as another potential contributor to kidney and immune-cell injury.

Why is this important?

Most current therapies for autoimmune kidney disease focus on suppressing or modifying the immune response.

But if abnormal cellular metabolism is helping sustain that response, future treatments might also target pathways such as glycolysis, mitochondrial oxidation, or iron metabolism.

This is still an emerging area of research, not yet a basis for routine metabolic treatment of autoimmune kidney disease.

But it reinforces a broader principle: immune function and metabolism are deeply interconnected.

Understanding those connections may eventually lead to more precise ways to treat autoimmune kidney injury.

📚 Read the study link in profile: https://www.nature.com/articles/s41581-026-01096-8

12/09/2026

A new perspective in the Clinical Journal of the American Society of Nephrology highlights the growing connection between metabolic dysfunction-associated steatotic liver disease (MASLD), cardiovascular disease, and chronic kidney disease (CKD).

MASLD, formerly called nonalcoholic fatty liver disease, now affects more than one-third of adults worldwide.

But it is increasingly clear that MASLD is not simply a liver problem.

It often exists alongside CKD and cardiovascular disease because all three share common drivers, including:

🔹 Insulin resistance
🔹 Chronic inflammation
🔹 Metabolic dysfunction
🔹 Endothelial injury
🔹 Fibrosis

People with MASLD are more likely to experience declining kidney function, cardiovascular events, and premature death.

The authors argue that MASLD should be viewed as part of the broader cardiovascular-kidney-metabolic (CKM) syndrome, rather than treated as an isolated condition.

Why does this matter?

Fat accumulation and fibrosis in the liver may amplify systemic metabolic stress and potentially contribute to injury in the blood vessels, heart, and kidneys.

Yet MASLD remains underrecognized in both nephrology and cardiology.

Identifying liver fibrosis with noninvasive tools, alongside kidney and cardiovascular risk assessment, could help identify high-risk patients earlier.

Lifestyle intervention remains foundational, while therapies such as GLP-1 receptor agonists, SGLT2 inhibitors, mineralocorticoid receptor antagonists, and newer liver-directed medications may offer benefits across multiple organs.

The bigger picture

Instead of treating fatty liver, CKD, diabetes, and cardiovascular disease as separate problems, we may need to target the underlying metabolic dysfunction connecting them all.

Earlier recognition of MASLD could provide another opportunity to intervene before liver, kidney, and cardiovascular disease progress.

📚 Read the study in profile: https://www.ovid.com/10.2215/CJN.0000001209

11/09/2026

A new study in the Clinical Journal of the American Society of Nephrology compared kidney outcomes among people with CKD starting statins, fibrates, or niacin.

Researchers analyzed more than 68,000 U.S. Veterans with newly diagnosed CKD and followed outcomes for up to 10 years.

The key finding:

👉 Compared with statins, people starting fibrates had a slightly slower decline in eGFR over time.

Over 10 years, the difference in eGFR slope was about 0.26 mL/min/1.73 m² per year in favor of fibrates.

Niacin was not associated with a significant difference in eGFR decline compared with statins.

However, fibrates and niacin did not significantly reduce major adverse kidney events, including severe loss of kidney function, kidney failure, or death.

👉👉👉An important caveat

Fenofibrate, one of the most commonly used fibrates, is well known to cause a rise in serum creatinine that can be reversible and may not always represent true structural kidney injury or a genuine fall in GFR.

That matters because eGFR is usually calculated from serum creatinine. In other words, fibrates can complicate how we interpret changes in kidney function based on creatinine alone.

Interestingly, despite this known creatinine effect, fibrate users in this study still showed a somewhat slower long-term eGFR decline than statin users.

The bigger picture

CKD is often associated with high triglycerides and abnormal HDL metabolism. While statins remain well established for cardiovascular risk reduction, the kidney effects of triglyceride-lowering therapies are less certain.

These findings raise the possibility that fibrates may have kidney-protective effects, but this was an observational study and cannot prove causation.
More research, ideally including measures of kidney function that are less dependent on creatinine, is needed before changing treatment recommendations.

📚 Read the study here: https://www.ovid.com/10.2215/CJN.0000001188

10/09/2026

👁️ Could an eye exam reveal clues about kidney and cardiovascular health?

A new perspective in the Clinical Journal of the American Society of Nephrology explores retinal oculomics, using images of the retina as a window into cardiovascular-kidney-metabolic (CKM) health.

Why the eye?

The tiny blood vessels of the retina share important features with the kidney’s microvasculature. Both are vulnerable to:

🔹 High blood pressure
🔹 Diabetes and metabolic dysfunction
🔹 Vascular injury
🔹 Inflammation and hemodynamic stress

Retinal changes have already been associated with future stroke, cardiovascular death, coronary heart disease, hypertension, diabetes, and chronic kidney disease.

Now, artificial intelligence may take this further.

AI can analyze retinal photographs for subtle patterns that may help estimate systemic biomarkers or identify people at higher cardiometabolic risk.

For kidney disease, however, the science is still early. Current retinal AI models have mainly focused on detecting CKD or predicting who may develop it. They have not yet been adequately tested for outcomes such as progressive kidney function loss, albuminuria, dialysis, transplantation, or kidney-related mortality.

People with advanced CKD, dialysis patients, and transplant recipients are also underrepresented in current studies.

The bigger picture

Heart, kidney, and metabolic disease are increasingly recognized as interconnected.

In the future, a simple retinal photograph could potentially help identify not only eye disease, but also people at increased risk for CKD, cardiovascular disease, or metabolic dysfunction.

We are not there yet, but retinal AI may eventually become a useful tool for earlier screening and more personalized risk assessment.

👁️ The eye may tell us much more about whole-body health than we once realized.

📚 Read the study, link in bio. https://www.ovid.com/10.2215/CJN.0000001224

09/09/2026

A new study published in Kidney360 examined 274 adults with non-dialysis CKD and found an interesting relationship between protein, dietary fiber, and blood urea nitrogen (BUN).

As expected, higher protein intake was associated with higher BUN.

But there was an important twist:

👉 In people with low or moderate fiber intake, higher protein intake was associated with higher BUN.
👉 In those with the highest fiber intake, that association was substantially weaker and was no longer statistically significant.

People consuming more fiber also tended to eat more fruits and vegetables, along with fish and eggs.

Why might fiber matter?

Dietary fiber can influence the gut microbiome, intestinal nitrogen metabolism, bowel elimination, and the production and absorption of nitrogen-containing compounds. This raises an intriguing possibility that increasing fiber could help reduce some of the uremic burden associated with protein intake.

The practical takeaway

For people with CKD, the conversation may not simply be:

“How much protein should I eat?”

It may also need to include:

“How much fiber am I eating along with it?”

A diet richer in appropriate plant foods may potentially allow greater nutritional flexibility while helping manage BUN.

Importantly, this study shows an association, not proof that increasing fiber will lower BUN or make higher protein intake safe in CKD. The authors appropriately call for further studies to determine whether increasing dietary fiber could eventually allow more liberal protein recommendations.

Still, it reinforces an increasingly important principle in kidney nutrition:

🌱 The quality and overall composition of the diet may matter just as much as individual nutrient targets.

Read the study [link in bio]

https://www.ovid.com/10.34067/KID.0000001350

08/09/2026

Not quite.

Your kidneys actively regulate water throughout the day, and that regulation changes according to your circadian rhythm.

During the daytime, kidney filtration and urine production are generally higher. At night, the body shifts toward conserving water so you can sleep without repeatedly needing to urinate.

That’s why a better strategy for many people is to drink regularly during the day instead of loading up on fluids before bed.

And if you have CKD, heart failure, kidney stones, or significant nighttime urination, fluid timing and volume may need to be individualized.

Read more: When Is the Best Time to Drink Water? Circadian Rhythm, Hydration and Kidney Health

Link in profile: https://inkidney.com/best-time-to-drink-water-kidney-health

07/09/2026

⚖️ Weight management may be becoming an increasingly important part of chronic kidney disease care.🫘

A new systematic review and meta-analysis examined 42 randomized controlled trials involving more than 11,000 adults with CKD and overweight or obesity.

The researchers found benefits across several approaches to intentional weight loss:

💉 Incretin-based medications reduced urine albumin-to-creatinine ratio (UACR) by 41%, suggesting an important kidney-protective effect.

⚖️ Bariatric surgery produced significant weight loss and was associated with improvement in eGFR.

🥗 Lifestyle interventions improved weight and body composition and produced modest reductions in blood pressure.

Why does this matter?

Obesity is a modifiable risk factor for both CKD progression and cardiovascular disease. These findings reinforce that treating obesity isn't simply about the number on the scale.

Weight loss interventions can improve metabolic health and may directly benefit important markers of kidney health.

With newer incretin-based anti-obesity therapies becoming more widely available, weight management deserves consideration as part of comprehensive CKD care, individualized to each patient.

The evidence for effects on cardiovascular events and mortality remains limited, so we still need longer-term studies.

👉 Read the full study to learn more [link in bio]

https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.70997

06/09/2026

Water balance is not static throughout the day. Your kidneys continuously adjust how much water they conserve or excrete, and one of the key hormones guiding this process is vasopressin, also known as ADH.

At night, vasopressin helps the kidneys conserve water and reduce urine production, which is one reason we can usually sleep for several hours without needing to urinate.

It also helps explain why urine is often more concentrated overnight and first thing in the morning.

The key takeaway?

Your kidneys are not doing exactly the same thing at 2 PM that they are doing at 2 AM.

Hydration is influenced not only by how much you drink, but also by your body’s circadian rhythm.

Read more in the blog [link in profile]

https://inkidney.com/best-time-to-drink-water-kidney-health

05/09/2026

💧 When is the best time to drink water?

Most hydration advice focuses on how much water we drink. But your kidneys also follow a circadian rhythm, meaning urine production, water conservation, blood pressure, and kidney filtration all change across the day.

For most healthy people, a practical approach is to:

• Start hydrating after waking
• Drink consistently through the morning and afternoon
• Avoid “catching up” on an entire day’s water right before bed
• Adjust intake for exercise, heat, medications, and medical conditions

More water is not always better. The kidneys are regulators of water, not filters that need to be constantly “flushed.”

Read the full article: When Is the Best Time to Drink Water? Circadian Rhythm, Hydration and Kidney Health

Link in bio

https://inkidney.com/best-time-to-drink-water-kidney-health

Integrative Kidney Institute

14/09/2026

13/09/2026

12/09/2026

11/09/2026

10/09/2026

09/09/2026

08/09/2026

07/09/2026

06/09/2026

05/09/2026

Address

Website

Alerts

Contact The Practice

Shortcuts

Share

Category

Listing takedown request