The kidney/s is a single organ system possessing three distinct functions. These are: secretory (hormonal), regulatory (homeostasis) and excretory (urinary elimination). The currently existing drug interventions address only the individual deficiencies on the pathophysiology and biochemical functions of the kidney. These three functions are in a dynamic equilibrium in any healthy individual, and so is the Gut Microbiome with trillions of microbes.

Prebiotics, probiotics and their combination termed as synbiotics could also play a role in reducing the generation and elimination of uremic toxins, more so in conjunction with standard care of therapy according to individual CKD patient, nutritional needs and disease conditions. The modulation of the intestinal microbiota composition with the use of probiotics/prebiotics could potentially minimize the deleterious effects of its imbalance, thereby improving the health of the gastrointestinal tract, strengthening the immune system, restoring the bioavailability of micronutrients, exerting anti diabetic actions, improving dyslipidemia and allergic disorders, and reducing the risk of other health problems. 

The mechanism by which probiotics exert their favourable effects seems due to direct utilization of several uremic toxins as its nutrients for the gut microbial growth with its inherent capabilities of multiplying and doubling every 20 to 25 minutes. The increased growth of these gut microbes are then eliminated by the natural defecation process which has been referred to as “Enteric Dialysis”