Intestinal microbiota status in patients with type 2 diabetes mellitus depending on the presence of chronic pyelonephritis at pre-dialysis stages of chronic kidney disease – an observational case-control study

N.V. Sturov, S.V. Popov, Zh.D. Kobalava, I.I. Belikov, V.A. Zhukov, T.V. Lyapunova, T.A. Meleshkevich

Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia

Background: Type 2 diabetes mellitus (DM2) is one of the main causes of chronic kidney disease (CKD) and end-stage renal failure. The medical community continues to debate the possible impact of intestinal microbiota (IM) imbalances on CKD progression. IM is a collection of microorganisms that play an important role in maintaining the health of the macroorganism and participate in various physiological processes. One of the urgent problems is the study of the composition of IM in patients with CKD and DM2. Most studies of IM were conducted in patients with CKD stages 4-5. This article presents the results of a study of the state of IM in diabetic patients with CKD at pre-dialysis stages in combination with chronic pyelonephritis (CP), obtained by gas chromatography-mass spectrometry (GCMS) using the microbial marker mass spectrometry (MMMS) method. Objective. Evaluation of the composition of IM in the Moscow population of patients with DM2 in combination with CP at pre-dialysis stages of CKD by GCMS of fecal samples using the MMMS method. Materials and methods: The IM analysis was conducted from 2021 to 2024 in 69 patients (23 patients with DM2 and CKD stages 3-4; 9 with CKD stages 3-4 with DM2 in combination with CP; 23 with DM2 and CKD stage 2; 14 with DM2 and without CKD) and 26 healthy volunteers. Results: It was found that in patients with DM2 without CKD, compared with healthy volunteers, there was a significant decrease in the number of Prevotella spp., Propionibacterium jensenii and Bacteroides fragilis, as well as a significant increase in Bacillus megaterium (Priestia megaterium) (p<0.05). In the group of patients with DM2 and stage 2 CKD, compared with patients with DM2 only, an increase in the number of Fusobacterium spp./Haemophilus spp. (p<0.05) was found. Comparison of patients with DM2 and stage 3–4 CKD with patients with DM2 and stage 2 CKD showed a decrease in Lactobacillus spp. and Ruminococcus spp. in the group of DM2 and stage 3–4 CKD. At the same time, these patients showed a significant increase in Propionibacterium acnes (Cutibacterium acnes) and Actinomyces spp. (p<0.05). In patients with DM2 and stage 3–4 CKD with exacerbation of chronic pyelonephritis who received antimicrobial therapy, a significant increase in the number of Rhodococcus spp., total microbial load, total bacterial load, anaerobes and Peptostreptococcus anaerobius 18623 was found compared to patients with DM2 and stage 3-4 CKD without CP (all p < 0.05). Conclusion: In this study, for the first time in the Moscow population, the composition of IM in patients with DM2 at various pre-dialysis stages of CKD was studied and compared. The results obtained determine the need for further study of the role of IM and the prognostic value of its changes in the progression of CKD.

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About the Authors

N.V. Sturov, Cand. Sci. (Med.), Associate Professor, Head of the Department of General Practice, Institute of Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; sturov_nv@pfur.ru, ORCID: https://orcid.org/0000-0002-3138-8410,
Sergey V. Popov, Dr. Sci. (Med.), Professor of the Department of General Practice, Institute of Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; popov_serv@pfur.ru, ORCID: https://orcid.org/0000-0002-0567-4616 (corresponding author),
Zh.D. Kobalava, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Internal Diseases with a course in Cardiology and Functional Diagnostics named after Academician V. S. Moiseev, Institute of Medicine; Head of the Institute of Clinical Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; kobalava_zhd@pfur.ru, ORCID: https://orcid.org/0000-0002-5873-1768
I.I. Belikov, Assistant of the Department of General Practice, Institute of Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; belikov_ii@pfur.ru, ORCID: https://orcid.org/0000-0001-5141-2193,
V.A. Zhukov, Cand. Sci. (Med.), Associate Professor of the Department of General Practice, Institute of Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; zhukov_vlan@rudn.ru, ORCID: https://orcid.org/0000-0001-9995-264X
T.V. Lyapunova, Cand. Sci. (Med.), Associate Professor of the Department of Medical Informatics and Telemedicine, Institute of Medicine, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; lyapunova_tv@pfur.ru, ORCID: https://orcid.org/0000-0002-1141-0764,
T.A. Meleshkevich, Cand. Sci. (Med.), Associate Professor of the Department of Hospital Therapy with Courses in Endocrinology, Hematology and Clinical Laboratory Diagnostics, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; meleshkevich_ta@pfur.ru, ORCID: https://orcid.org/0000-0003-3229-3357

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