Gastrointestinal Dysbiosis and Resistant Hypertension in Chronic Kidney Disease: Mechanisms, Clinical Evidence, and Therapeutic Perspectives

Resistant hypertension (RH) is disproportionately prevalent in patients with chronic kidney disease (CKD) and is strongly associated with accelerated cardiovascular morbidity and CKD progression. Emerging evidence suggests that gastrointestinal dysbiosis may represent a modifiable contributor to RH through multiple converging mechanisms, including accumulation of protein-bound uremic toxins, impaired short-chain fatty acid signaling, heightened systemic inflammation and oxidative stress, sympathetic activation, altered bile acid metabolism, increased intestinal permeability, and microbe–drug interactions that attenuate antihypertensive efficacy. This review synthesizes mechanistic, clinical, and translational evidence linking gut dysbiosis to RH in CKD, with a focus on therapeutic strategies and unmet needs. Finally, critical research gaps were outlined and a pragmatic agenda was proposed for translational studies and precision microbiome-guided interventions aimed at improving blood pressure control and cardiovascular-renal outcomes.

Cite this article as: Ćićarić N, Đukić V. Gastrointestinal dysbiosis and resistant hypertension in chronic kidney disease: mechanisms, clinical evidence, and therapeutic perspectives. Turk J Nephrol. Published online May 22, 2026. doi: 10.5152/turkjnephrol.2025.251200.