Microbiota analysis in the hemodialysis population — Focusing on Enterobacteriaceae

Abstract

Background:
Infection is a recognized risk factor for mortality among hemodialysis patients, including infection caused by Enterobacteriaceae. We aimed to investigate Enterobacteriaceae in gut microbiota among hemodialysis patients and to analyze associations between microbiota and clinical parameters

Materials and Methods:
This prospective study of microbiota analysis in hemodialysis patients was conducted in April-May 2018. A control group without recent antibiotic use or hospitalization was used for comparison. Stool samples underwent 16S rRNA sequencing, using Greengenes 16S rRNA database for microbiota analysis.

Results:
Among 96 hemodialysis (HD) patients, mean age was 61.9±0.8 years and mean duration of HDwas 6.5±0.7 years. No significant differences were found in alpha diversity between HD and control groups (HD group 949.5, controls 898; p=0.16) although significant between-group differences were found in beta diversity(P<0.001). At phylum level, HD group hada higher abundance of Firmicutes (median 0.58 [0.1-0.96] vs. 0.53 [0.09-0.88]; p= 0.034) and Proteobacteria (median 0.06 [0-0.68] vs. 0.02 [0-0.68]; p=0.005), but lower abundance of Bacteriodetes (median 0.12 [0.002-0.63] vs. 0.29 [0.002-0.82];p=0.001). At genus level, the five most frequentoperational taxonomic unit (OTU) IDs were Escherichia-Shigella complex (3), Escherichia and Klebsiella. 

Conclusions:

Alpha diversity in HD patients is not lower than that in healthy controls but significant between-group differences are found in microbiota composition according to beta diversity, due to decreased Bacteriodetesand increased Firmicutes and Proteobacteria. HD patients have a higher abundance of Proteobacteria in spite of reserved diversity, but without correlation with clinical factors.