Gut Microbiota-Dependent Trimethylamine N -Oxide (TMAO) Pathway Contributes to Both Development of Renal Insufficiency and Mortality Risk in Chronic Kidney Disease

Median plasma TMAO level among CKD subjects was 7.9 μmol/L, significantly higher than in non-CKD subjects.

• Higher plasma TMAO levels in CKD patients are associated with a 2.8-fold increased risk of mortality over 5 years.
• After accounting for traditional risk factors, elevated TMAO levels remain a significant predictor of 5-year mortality in CKD patients.
• TMAO provides additional prognostic value beyond traditional risk factors in assessing mortality risk.
• In non-CKD subjects, elevated TMAO levels indicate a poorer prognosis regardless of cystatin C levels.
• Animal models demonstrate that increased dietary choline or TMAO can directly lead to renal tubulointerstitial fibrosis and dysfunction.

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