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Article

Distinct Gut Microbiome Signatures in Hemodialysis and Kidney Transplant Populations

by
Luminita Voroneanu
1,2,
Andreea Covic
1,2,*,
Stefan Iliescu
1,
Cezar Valeriu Baluta
1,2,
Bogdan Dumitru Agavriloaei
1,2,
Anca Elena Stefan
1,2,
Roxana-Maria Amărandi
3,4,
Irina-Cezara Văcărean-Trandafir
4,
Iuliu-Cristian Ivanov
4 and
Adrian Covic
1,2
1
Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania
2
Nephrology Clinic, Dialysis, and Renal Transplant Center, “C.I. Parhon” University Hospital, 700503 Iasi, Romania
3
Faculty of Automatics, Technical University of Sofia, Kliment Ohridski Boulevard 8, 1756 Sofia, Bulgaria
4
TRANSCEND Research Centre, Regional Institute of Oncology, 2-4 General Henri Mathias Berthelot Street, 700483 Iasi, Romania
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(22), 8032; https://doi.org/10.3390/jcm14228032
Submission received: 30 September 2025 / Revised: 26 October 2025 / Accepted: 5 November 2025 / Published: 12 November 2025
(This article belongs to the Section Nephrology & Urology)
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Abstract

Background: Gut microbiota plays a critical role in host metabolism, immunity, and intestinal barrier integrity. Both chronic kidney disease (CKD) and kidney transplantation (KTR) are associated with gut dysbiosis, driven by uremic toxins, comorbidities, and immunosuppressive therapy. However, direct comparisons between hemodialysis (HD), KTR, and healthy controls (HC), while accounting for dietary factors, remain limited. Methods: We conducted a cross-sectional study including 48 HD patients, 75 KTR patients, and 13 HC. Stool patient samples were analyzed using 16S rRNA amplicon sequencing targeting the V4-V4 region to assess microbial composition and diversity. Data on clinical status, laboratory parameters, and dietary intake were collected and integrated with microbiome profiling. Results: Firmicutes and Bacteroidota dominated all groups, with Akkermansia enriched in HD and SCFA-producing genera (Faecalibacterium, Roseburia) more abundant in KTR. LEfSe and sPLS-DA analyses identified Akkermansia and Clostridia-related taxa as discriminants of HD, while Acidaminococcus and Megasphaera characterized KTR. HD patients exhibited higher alpha diversity (Faith’s PD and Chao1) than KTR (p < 0.05). Dietary intake differed across groups, but explained only a small proportion of microbial variance. Conclusions: Both HD and KTR patients display persistent gut dysbiosis with distinct microbial signatures. While transplantation partially restores SCFA producers, immunosuppression and diet shape new ecological shifts. These findings underscore the potential of microbiota as a biomarker and therapeutic target in renal replacement therapies.
Keywords: gut microbiota; chronic kidney disease; hemodialysis; kidney transplantation; dysbiosis gut microbiota; chronic kidney disease; hemodialysis; kidney transplantation; dysbiosis

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MDPI and ACS Style

Voroneanu, L.; Covic, A.; Iliescu, S.; Baluta, C.V.; Agavriloaei, B.D.; Stefan, A.E.; Amărandi, R.-M.; Văcărean-Trandafir, I.-C.; Ivanov, I.-C.; Covic, A. Distinct Gut Microbiome Signatures in Hemodialysis and Kidney Transplant Populations. J. Clin. Med. 2025, 14, 8032. https://doi.org/10.3390/jcm14228032

AMA Style

Voroneanu L, Covic A, Iliescu S, Baluta CV, Agavriloaei BD, Stefan AE, Amărandi R-M, Văcărean-Trandafir I-C, Ivanov I-C, Covic A. Distinct Gut Microbiome Signatures in Hemodialysis and Kidney Transplant Populations. Journal of Clinical Medicine. 2025; 14(22):8032. https://doi.org/10.3390/jcm14228032

Chicago/Turabian Style

Voroneanu, Luminita, Andreea Covic, Stefan Iliescu, Cezar Valeriu Baluta, Bogdan Dumitru Agavriloaei, Anca Elena Stefan, Roxana-Maria Amărandi, Irina-Cezara Văcărean-Trandafir, Iuliu-Cristian Ivanov, and Adrian Covic. 2025. "Distinct Gut Microbiome Signatures in Hemodialysis and Kidney Transplant Populations" Journal of Clinical Medicine 14, no. 22: 8032. https://doi.org/10.3390/jcm14228032

APA Style

Voroneanu, L., Covic, A., Iliescu, S., Baluta, C. V., Agavriloaei, B. D., Stefan, A. E., Amărandi, R.-M., Văcărean-Trandafir, I.-C., Ivanov, I.-C., & Covic, A. (2025). Distinct Gut Microbiome Signatures in Hemodialysis and Kidney Transplant Populations. Journal of Clinical Medicine, 14(22), 8032. https://doi.org/10.3390/jcm14228032

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