Chronic Disease Control

Research progress on the treatment of diabetic kidney disease with traditional chinese medicine based on gut microbiota

  • Qiuyu ZHOU ,
  • Xinyu SUN
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  • 1.Second Clinical Medical College of Henan University of Traditional Chinese Medicine,Zhengzhou 450002,Henan,China
    2.Department of Endocrinology,Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou 450002,Henan,China

Received date: 2026-01-23

  Online published: 2026-06-15

Abstract

Diabetic kidney disease (DKD) stands as one of the most prevalent and severe microvascular complications of diabetes mellitus (DM), serving as the primary cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD). This imposes a substantial burden on both patients and society from health and economic perspectives. The gut microbiota represents the aggregate of all microorganisms inhabiting the human intestine, forming an extremely intricate and extensive ecosystem. The organic interplay between the gut microbiota and the kidneys has been verified to directly or indirectly influence human health. Specifically, dysbiosis of the gut microbiota, impairment of the intestinal barrier, and imbalance of gut microbiota metabolites can initiate oxidative stress and immune-inflammatory responses, thereby accelerating the progression of DKD. In recent years, traditional Chinese medicine has manifested unique advantages in the prevention and treatment of DKD, attributed to its multi-target approach, holistic regulation, and minimal side effects. Studies have revealed that various compounds, including monosaccharide glycosides, flavonoids, polyphenols, terpenoids, alkaloids, polysaccharides, as well as traditional Chinese medicine formulas categorized as removing blood stasis and clearing turbidity, tonifying qi and nourishing yin, and clearing heat and detoxifying, can regulate the gut microbiota, target relevant signaling pathways, alleviate renal damage, and delay the progression of DKD. This article systematically reviews the key mechanisms through which the gut microbiota is involved in DKD, analyzes the research achievements in regulating the gut microbiota for the treatment of DKD in recent years, and aims to offer new insights and directions for the prevention and treatment of DKD with traditional Chinese medicine.

Cite this article

Qiuyu ZHOU , Xinyu SUN . Research progress on the treatment of diabetic kidney disease with traditional chinese medicine based on gut microbiota[J]. The Journal of Practical Medicine, 2026 , 42(11) : 1996 -2006 . DOI: 10.3969/j.issn.1006-5725.2026.11.014

References

[1] SUN H, SAEEDI P, KARURANGA S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J]. Diabetes Res Clin Pract, 2022, 183: 109119. doi: 10.1016/J.diabres.2021.109119 .
[2] THOMAS M C, BROWNLEE M, SUSZTAK K, et al. Diabetic kidney disease[J]. Nat Rev Dis Primers, 2015, 1: 15018. doi: 10.1038/NRDP.2015.18 .
[3] LIU W, WANG L, OU J, et al. Gut Microbiota Metabolites and Chronic Diseases: Interactions, Mechanisms, and Therapeutic Strategies[J]. Int J Mol Sci, 2025, 26(8): 3752. doi: 10.3390/IJMS26083752 .
[4] GIORDANO L, MIHAILA S M, ESLAMI AMIRABADI H, et al. Microphysiological Systems to Recapitulate the Gut-Kidney Axis[J]. Trends Biotechnol, 2021, 39(8): 811-823. doi: 10.1016/j.tibtech.2020.12.001 .
[5] WU X, ZHAO L, ZHANG Y, et al. The role and mechanism of the gut microbiota in the development and treatment of diabetic kidney disease[J]. Front Physiol, 2023, 14: 1166685. doi: 10.3389/fphys.2023.1166685 .
[6] ZAKY A, GLASTRAS S J, WONG M Y W, et al. The Role of the Gut Microbiome in Diabetes and Obesity-Related Kidney Disease[J]. Int J Mol Sci, 2021, 22(17): 9614. doi: 10.3390/IJMS22179641 .
[7] TIAN E, WANG F, ZHAO L, et al. The pathogenic role of intestinal flora metabolites in diabetic nephropathy[J]. Front Physiol, 2023, 14: 1231621. doi: 10.3389/fphys.2023.1231621 .
[8] LIN J, WANG Z, SUN J, et al. Gut microbiota and diabetic kidney diseases: Pathogenesis and therapeutic perspectives[J]. World J Diabetes, 2022, 13(4): 308-318. doi: 10.4239/WJD.V13.i4.308 .
[9] ZHANG Y, QING J, SAED Y A, et al. Gut microbiota implication in diabetic kidney disease: Mechanisms and novel therapeutic strategies[J]. Ren Fail, 2025, 47(1): 2517402. doi: 10.1080/0886022X.2025.2517402 .
[10] SUZUKI T. Regulation of the intestinal barrier by nutrients: The role of tight junctions[J]. Anim Sci J, 2020, 91(1): e13357. doi: 10.1111/ASJ.13357 .
[11] WANG P, WANG T, ZHENG X, et al. Gut microbiota, key to unlocking the door of diabetic kidney disease[J]. Nephrology (Carlton), 2021, 26(8): 641-649. doi: 10.1111/nep.13874 .
[12] TAO P, JI J, WANG Q, et al. The role and mechanism of gut microbiota-derived short-chain fatty in the prevention and treatment of diabetic kidney disease[J]. Front Immunol, 2022, 13: 1080456. doi: 10.3389/fimmu.2022.1080456 .
[13] AN J, LIU Y, WANG Y, et al. The Role of Intestinal Mucosal Barrier in Autoimmune Disease: A Potential Target[J]. Front Immunol, 2022, 13: 871713. doi: 10.3389/fimmu.2022.871713 .
[14] LINH H T, IWATA Y, SENDA Y, et al. Intestinal Bacterial Translocation Contributes to Diabetic Kidney Disease[J]. J Am Soc Nephrol, 2022, 33(6): 1105-1119. doi: 10.1681/ASN. 2021060843 .
[15] FARRE R, DEJONGH S, MEIJERS B. Of Mice and MAVS-Diabetic Kidney Disease and the Leaky Gut[J]. J Am Soc Nephrol, 2022, 33(6): 1053-1055. doi: 10.1681/ASN. 2022040407 .
[16] SNELSON M, DE PASQUALE C, EKINCI E I, et al. Gut microbiome, prebiotics, intestinal permeability and diabetes complications[J]. Best Pract Res Clin Endocrinol Metab, 2021, 35(3): 101507. doi: 10.1016/J.Beem.2021.101507 .
[17] 陈慧, 鲁一兵. 肠道菌群与糖尿病性肾小球硬化的研究进展[J]. 实用医学杂志, 2021, 37(3): 415-418. doi: 10.3969/j.issn.1006-5725.2021.03.028 .
[18] GONZALEZ A, KRIEG R, MASSEY H D, et al. Sodium butyrate ameliorates insulin resistance and renal failure in CKD rats by modulating intestinal permeability and mucin expression[J]. Nephrol Dial Transplant, 2019, 34(5): 783-794. doi: 10.1093/ndt/gfy238 .
[19] CAI K, MA Y, CAI F, et al. Changes of gut microbiota in diabetic nephropathy and its effect on the progression of kidney injury[J]. Endocrine, 2022, 76(2): 294-303. doi: 10.1007/S12020-022-03002-1 .
[20] LU J, CHEN P P, ZHANG J X, et al. GPR43 activation-mediated lipotoxicity contributes to podocyte injury in diabetic nephropathy by modulating the ERK/EGR1 pathway[J]. Int J Biol Sci, 2022, 18(1): 96-111. doi: 10.7150/ijbs.64665 .
[21] LUO L, LUO J, CAI Y, et al. Inulin-type fructans change the gut microbiota and prevent the development of diabetic nephropathy[J]. Pharmacol Res, 2022, 183: 106367. doi: 10.1016/j.phrs. 2022.106367 .
[22] AHMED S, SPARIDANS R W, VERNOOIJ R W M, et al. Protein-bound uremic toxin clearance as biomarker of kidney tubular function in diabetic kidney disease[J]. Sci Rep, 2025, 15(1): 23406. doi: 10.1038/s41598-025-07248-3 .
[23] LIU W, TOMINO Y, LU K. Impacts of Indoxyl Sulfate and p-Cresol Sulfate on Chronic Kidney Disease and Mitigating Effects of AST-120[J]. Toxins (Basel), 2018, 10(9): 367. doi: 10.3390/toxins10090367 .
[24] FANG Q, ZHENG B, LIU N, et al. Trimethylamine N-Oxide Exacerbates Renal Inflammation and Fibrosis in Rats With Diabetic Kidney Disease[J]. Front Physiol, 2021, 12: 682482. doi: 10.3389/fphys.2021.682482 .
[25] ANDRIKOPOULOS P, ARON-WISNEWSKY J, CHAKAROUN R, et al. Evidence of a causal and modifiable relationship between kidney function and circulating trimethylamine N-oxide[J]. Nat Commun, 2023, 14(1): 5843. doi: 10.1038/s41467-023-39824-4 .
[26] XIAO X, ZHANG J, JI S, et al. Lower bile acids as an independent risk factor for renal outcomes in patients with type 2 diabetes mellitus and biopsy-proven diabetic kidney disease[J]. Front Endocrinol (Lausanne), 2022, 13: 1026995. doi: 10.3389/fendo.2022.1026995 .
[27] LIU P, JIN M, HU P, et al. Gut microbiota and bile acids: Metabolic interactions and impacts on diabetic kidney disease[J]. Curr Res Microb Sci, 2024, 7: 100315. doi: 10.1016/J.Crmicr. 2024.100315 .
[28] WANG X X, WANG D, LUO Y, et al. FXR/TGR5 Dual Agonist Prevents Progression of Nephropathy in Diabetes and Obesity[J]. J Am Soc Nephrol, 2018, 29(1): 118-137. doi: 10.1681/ASN.2017020222 .
[29] YANG Z, XIONG F, WANG Y, et al. TGR5 activation suppressed S1P/S1P2 signaling and resisted high glucose-induced fibrosis in glomerular mesangial cells[J]. Pharmacol Res, 2016, 111: 226-236. doi: 10.1016/j.phrs.2016.05.035 .
[30] MARQUARDT A, AL-DABET M M, GHOSH S, et al. Farnesoid X Receptor Agonism Protects against Diabetic Tubulopathy: Potential Add-On Therapy for Diabetic Nephropathy[J]. J Am Soc Nephrol, 2017, 28(11): 3182-3189. doi: 10.1681/ASN. 2016101123 .
[31] 梁磊, 念馨. 肠道菌群:未来2型糖尿病治疗的新靶点[J]. 实用医学杂志, 2022, 38(3): 261-265. doi: 10.3969/j.issn.1006-5725.2022.03.001 .
[32] WANG M, GONG Q, ZHA C, et al. Low-dose lipopolysaccharide inducing continuous and obvious increase in urinary protein in hyperglycemic rats and the underlying mechanism[J]. PLoS One, 2023, 18(7): e288876. doi: 10.1371/journal.pone. 0288876 .
[33] LINDFORS S, POLIANSKYTE-PRAUSE Z, BOUSLAMA R, et al. Adiponectin receptor agonist AdipoRon ameliorates renal inflammation in diet-induced obese mice and endotoxin-treated human glomeruli ex vivo[J]. Diabetologia, 2021, 64(8): 1866-1879. doi: 10.1007/s00125-021-05473-9 .
[34] NI Y, DU H, KE L, et al. Gut-kidney interaction reinforces dapagliflozin-mediated alleviation in diabetic nephropathy[J]. Am J Physiol Cell Physiol, 2025, 328(2): C452-C466. doi: 10.1152/ajpcell.00651.2024 .
[35] CHEN Q, REN D, LIU L, et al. Ginsenoside Compound K Ameliorates Development of Diabetic Kidney Disease through Inhibiting TLR4 Activation Induced by Microbially Produced Imidazole Propionate[J]. Int J Mol Sci, 2022, 23(21): 12863. doi: 10.3390/ijms232112863 .
[36] LYU X, ZHANG T, YE Z, et al. Astragaloside IV Mitigated Diabetic Nephropathy by Restructuring Intestinal Microflora and Ferroptosis[J]. Mol Nutr Food Res, 2024, 68(6): e2300734. doi: 10.1002/mnfr.202300734 .
[37] CHAI Y, LUO J, BAO Y. Effects of Polygonatum sibiricum saponin on hyperglycemia, gut microbiota composition and metabolic profiles in type 2 diabetes mice[J]. Biomed Pharmacother, 2021, 143: 112155. doi: 10.1016/j.biopha.2021.112155 .
[38] MA C, JU B, LIU J, et al. Phenylethanol Glycosides from Cistanche tubulosa Modulate the Gut Microbiota and Cecal Metabolites to Ameliorate Diabetic Nephropathy Induced by Streptozotocin Combined with High-Fat Diet in Rats[J]. J Med Food, 2025, 28(3): 219-231. doi: 10.1089/jmf.2024.k.0175 .
[39] LIAO H, ZHAO Y, LIANG Y, et al. Flavonoids Derived from Opuntia ficus-indica Fruit Alleviate Renal Injury in Diabetic Nephropathy Mice by Altering Gut Microbiota and Promoting the Production of SCFAs[J]. Nutrients, 2025, 17(11): 1800. doi: 10.3390/nu17111800 .
[40] 于晓依, 常畅, 陈天笑, 等. 王不留行黄酮苷改善糖尿病肾病小鼠肠道菌群紊乱和肾脏脂质沉积的研究[J]. 华西药学杂志, 2024, 39(1): 36-42. doi: 10.13375/j.cnki.wcjps.2024. 01.008 .
[41] YUAN L, LI X, HE S, et al. Effects of Natural Flavonoid Isoorientin on Growth Performance and Gut Microbiota of Mice[J]. J Agric Food Chem, 2018, 66(37): 9777-9784. doi: 10.1021/acs.jafc.8b03568 .
[42] PENG B, DAI J, JI S, et al. Quercetin ameliorates hyperuricemic nephropathy through improving gut dysfunctions and decreasing gut bacteria-derived uremic toxins[J]. Phytomedicine, 2025, 143: 156801. doi: 10.1016/j.phymed.2025.156801 .
[43] YAN H, ZHANG Y, LIN X, et al. Resveratrol improves diabetic kidney disease by modulating the gut microbiota-short chain fatty acids axis in db/db mice[J]. Int J Food Sci Nutr, 2024, 75(3): 264-276. doi: 10.1080/09637486.2024.2303041 .
[44] HUA Q, HAN Y, ZHAO H, et al. Punicalagin alleviates renal injury via the gut-kidney axis in high-fat diet-induced diabetic mice[J]. Food Funct, 2022, 13(2): 867-879. doi: 10.1039/d1fo03343c .
[45] LI C, CHEN X, YAO J, et al. Curcumin modulated gut microbiota and alleviated renal fibrosis in 5/6 nephrectomy-induced chronic kidney disease rats[J]. PLoS One, 2025, 20(1): e314029. doi: 10.1371/journal.pone.0314029 .
[46] LI X, CHEN H, HE Y, et al. Effects of Rich-Polyphenols Extract of Dendrobium loddigesii on Anti-Diabetic, Anti-Inflammatory, Anti-Oxidant, and Gut Microbiota Modulation in db/db Mice[J]. Molecules, 2018, 23(12): 3245. doi: 10.3390/molecules23123245 .
[47] WANG X, XU Y, WANG Y, et al. Poricoic Acid A Protects Against High-Salt-Diet Induced Renal Fibrosis by Modulating Gut Microbiota and SCFA Metabolism[J]. Plant Foods Hum Nutr, 2025, 80(2): 115.doi: 10.1007/s11130-025-01356-1 .
[48] NI Y, PAN Y, ZHOU J, et al. Asiaticoside and asiatic acid improve diabetic nephropathy by restoring podocyte autophagy and improving gut microbiota dysbiosis[J]. Biochem Pharmacol, 2025, 241: 117161. doi: 10.1016/j.bcp.2025.117161 .
[49] LIU W, XU S, ZHANG B, et al. Ramulus Mori (Sangzhi) Alkaloids Alleviate Diabetic Nephropathy through Improving Gut Microbiota Disorder[J]. Nutrients, 2024, 16(14): 2346. doi: 10.3390/nu16142346 .
[50] XU X, GAO Z, YANG F, et al. Antidiabetic Effects of Gegen Qinlian Decoction via the Gut Microbiota Are Attributable to Its Key Ingredient Berberine[J]. Genomics Proteomics Bioinformatics, 2020, 18(6): 721-736. doi: 10.1016/j.gpb.2019.09.007 .
[51] YANG X, XIN Y, GU Y, et al. Total alkaloids of Aconitum carmichaelii Debx alleviate cisplatin-induced acute renal injury by inhibiting inflammation and oxidative stress related to gut microbiota metabolism[J]. Phytomedicine, 2024, 135: 156128. doi: 10.1016/j.phymed.2024.156128 .
[52] XU G, YUAN H, LIU J, et al. Astragalus Mongholicus Polysaccharides Alleviate Kidney Injury in Rats with Type 2 Diabetes Through Modulation of Oxidation, Inflammation, and Gut Microbiota[J]. Int J Mol Sci, 2025, 26(4): 1470. doi: 10.3390/ijms26041470 .
[53] DONG W, ZHAO Y, LI X, et al. Corn silk polysaccharides attenuate diabetic nephropathy through restoration of the gut microbial ecosystem and metabolic homeostasis[J]. Front Endocrinol (Lausanne), 2023, 14: 1232132. doi: 10.3389/fendo.2023. 1232132 .
[54] YANG J, DONG H, WANG Y, et al. Cordyceps cicadae polysaccharides ameliorated renal interstitial fibrosis in diabetic nephropathy rats by repressing inflammation and modulating gut microbiota dysbiosis[J]. Int J Biol Macromol, 2020, 163: 442-456. doi: 10.1016/j.ijbiomac.2020.06.153 .
[55] JIA X, LIU H, YIN G, et al. Arctium lappaL. polysaccharides alleviate oxidative stress and inflammation in the liver and kidney of aging mice by regulating intestinal homeostasis[J]. Int J Biol Macromol, 2024, 280(Pt 2): 135802. doi: 10.1016/j.ijbiomac. 2024.135802 .
[56] ZHANG M, YANG L, ZHU M, et al. Moutan Cortex polysaccharide ameliorates diabetic kidney disease via modulating gut microbiota dynamically in rats[J]. Int J Biol Macromol, 2022, 206: 849-860. doi: 10.1016/j.ijbiomac.2022.03.077 .
[57] ZHOU R, WEN W, GONG X, et al. Nephro-protective effect of Daphnetin in hyperoxaluria-induced rat renal injury via alterations of the gut microbiota[J]. J Food Biochem, 2022, 46(12): e14377. doi: 10.1111/jfbc.14377 .
[58] LONG C, ZHANG C, XIE Y. Study on the mechanism of hirudin multi target delaying renal function decline in chronic kidney disease based on the "gut-kidney axis" theory[J]. Naunyn Schmiedebergs Arch Pharmacol, 2024, 397(10): 7951-7962. doi: 10.1007/s00210-023-02888-6 .
[59] ZENG Y, DAI Z, LU F, et al. Emodin via colonic irrigation modulates gut microbiota and reduces uremic toxins in rats with chronic kidney disease[J]. Oncotarget, 2016, 7(14): 17468-17478. doi: 10.18632/oncotarget.8160 .
[60] LAN T, TANG T, LI Y, et al. FTZ polysaccharides ameliorate kidney injury in diabetic mice by regulating gut-kidney axis[J]. Phytomedicine, 2023, 118: 154935. doi: 10.1016/j.phymed. 2023.154935 .
[61] 李鑫, 洪素珍, 李宝华, 等. 升清降浊胶囊通过调节肠道菌群对db/db糖尿病肾病小鼠肾脏的保护作用及其机制探讨[J]. 中药新药与临床药理, 2022, 33(6): 742-753. doi: 10.19378/j.issn.1003-9783.2022.06.004 .
[62] ZHAO T, ZHANG H, YIN X, et al. Tangshen formula modulates gut Microbiota and reduces gut-derived toxins in diabetic nephropathy rats[J]. Biomed Pharmacother, 2020, 129: 110325. doi: 10.1016/j.biopha.2020.110325 .
[63] CHEN Q, REN D, WU J, et al. Shenyan Kangfu tablet alleviates diabetic kidney disease through attenuating inflammation and modulating the gut microbiota[J]. J Nat Med, 2021, 75(1): 84-98. doi: 10.1007/s11418-020-01452-3 .
[64] LIU J, GAO L, FU B, et al. Efficacy and safety of Zicuiyin decoction on diabetic kidney disease: A multicenter, randomized controlled trial[J]. Phytomedicine, 2022, 100: 154079. doi: 10.1016/j.phymed.2022.154079 .
[65] 杜小梅, 潘薇, 梁颖兰, 等. 参芪地黄汤加减治疗气阴两虚型糖尿病肾病疗效观察及对肠道菌群和炎症因子的影响[J]. 中药新药与临床药理, 2021, 32(4): 566-572. doi: 10.19378/j.issn.1003-9783.2021.04.018 .
[66] SHI R, TAO Y, TANG H, et al. Abelmoschus Manihot ameliorates the levels of circulating metabolites in diabetic nephropathy by modulating gut microbiota in non-obese diabetes mice[J]. Microb Biotechnol, 2023, 16(4): 813-826. doi: 10.1111/1751-7915.14200 .
[67] GAO Y, YANG R, GUO L, et al. Qing-Re-Xiao-Zheng Formula Modulates Gut Microbiota and Inhibits Inflammation in Mice With Diabetic Kidney Disease[J]. Front Med (Lausanne), 2021, 8: 719950. doi: 10.3389/fmed.2021.719950 .
[68] HONG J, FU T, LIU W, et al. Jiangtang Decoction Ameliorates Diabetic Kidney Disease Through the Modulation of the Gut Microbiota[J]. Diabetes Metab Syndr Obes, 2023, 16: 3707-3725. doi: 10.2147/DMSO.S441457 .
[69] WEI H, WANG L, AN Z, et al. QiDiTangShen granules modulated the gut microbiome composition and improved bile acid pro?les in a mouse model of diabetic nephropathy[J]. Biomed Pharmacother, 2021, 133: 111061. doi: 10.1016/J.biopha.2020. 111061 .
[70] MO C, ZHAO J, LIANG J, et al. Effects of Zhuang medicine compound Xiancao Granule on diabetic kidney disease: A multi-omics analysis[J]. J Ethnopharmacol, 2024, 321: 117517. doi: 10.1016/J.JEP.2023.117517 .
[71] 姚宇剑, 倪雅丽, 李想, 等. 缩泉益肾方对糖尿病肾病小鼠肠道菌群多样性的影响[J]. 时珍国医国药, 2020, 31(8): 1846-1848. doi: 10.3969/j.issn.1008-0805.2020.08.017 .
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