Bhunyakarnjanarat T, Leelahavanichkul A, Chancharoenthana W. Microparticles at the crossroads of the gut-kidney axis: Mechanistic drivers and therapeutic horizons in hemodialysis. World J Nephrol 2026; 15(2): 118565 [DOI: 10.5527/wjn.v15.i2.118565]
Corresponding Author of This Article
Wiwat Chancharoenthana, MD, PhD, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 16/F Ratchanakarin Building 420/6 Rajvithi Road, Ratchathewi, Bangkok 10400, Thailand. wiwat.cha@mahidol.ac.th
Research Domain of This Article
Urology & Nephrology
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review-article
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Bhunyakarnjanarat T, Leelahavanichkul A, Chancharoenthana W. Microparticles at the crossroads of the gut-kidney axis: Mechanistic drivers and therapeutic horizons in hemodialysis. World J Nephrol 2026; 15(2): 118565 [DOI: 10.5527/wjn.v15.i2.118565]
Thansita Bhunyakarnjanarat, Asada Leelahavanichkul, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Thansita Bhunyakarnjanarat, Asada Leelahavanichkul, Center of Excellence on Translational Research in Inflammation and Immunology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
Wiwat Chancharoenthana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Wiwat Chancharoenthana, Tropical Immunology and Translational Research Unit, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
Co-corresponding authors: Asada Leelahavanichkul and Wiwat Chancharoenthana.
Author contributions: Chancharoenthana W and Leelahavanichkul A designed the core conceptualization and performed the validation; Bhunyakarnjanarat T and Leelahavanichkul A performed data curation; Chancharoenthana W performed visualization, performed formal analysis, provided supervision, and was responsible for funding acquisition and project administration; Bhunyakarnjanarat T developed the methodology and provided resources; Bhunyakarnjanarat T and Chancharoenthana W wrote the original draft; Bhunyakarnjanarat T, Chancharoenthana W, and Leelahavanichkul A performed the critical review and editing. All authors have read and approved the final manuscript. Both Chancharoenthana W and Leelahavanichkul A have played important and indispensable roles throughout the entire lifecycle of this project and thus qualify as co-corresponding authors of this manuscript. Chancharoenthana W applied for and secured the funding that supported this research. He conceptualized the overarching hypothesis linking microbiota-derived microparticles to the gut-kidney axis in hemodialysis patients, supervised all stages of the project from inception to completion, led the formal data analysis and visualization, coordinated the writing of the original draft, and served as the primary point of contact for journal correspondence and submission. Leelahavanichkul A provided critical intellectual input in the conceptualization and validation of the research framework, contributed to data curation, and played a central role in the critical review, revision, and refinement of the manuscript to ensure scientific rigor and accuracy. His expertise in immunology and gut-kidney interactions was instrumental in shaping the scientific narrative and interpreting key findings. This collaboration between Chancharoenthana W and Leelahavanichkul A was essential and indispensable for the successful completion and publication of this manuscript.
AI contribution statement: Grammarly only used for grammar and syntax checking. We did not use any AI text-generation tool. We wrote the entire manuscript by ourselves. No AI tool was used for polishing, translation, data analysis, or writing assistance. All intellectual content is from the authors. We created all figures using Canva and Microsoft PowerPoint.
Supported by Mahidol University (MU’s Strategic Research Fund): Fiscal Year 2023, No. MU-SRF-PF-03A/66.
Conflict-of-interest statement: All the authors declare no conflicts of interest related to this work.
Corresponding author: Wiwat Chancharoenthana, MD, PhD, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 16/F Ratchanakarin Building 420/6 Rajvithi Road, Ratchathewi, Bangkok 10400, Thailand. wiwat.cha@mahidol.ac.th
Received: January 6, 2026 Revised: January 27, 2026 Accepted: February 24, 2026 Published online: June 25, 2026 Processing time: 160 Days and 23.3 Hours
Abstract
Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) pose significant global health challenges, with hemodialysis serving as a vital treatment for ESKD patients. Despite its life-sustaining role, hemodialysis is associated with elevated cardiovascular morbidity and mortality, driven in part by the accumulation of uremic toxins. Recent research underscores the gut-kidney axis as a pivotal contributor to CKD progression and its complications, with gut microbiota dysbiosis amplifying uremic toxin production. Microparticles (MPs)-small extracellular vesicles released from cells-have emerged as key mediators in intercellular communication, inflammation, and vascular dysfunction. This review examines the role of MPs in the gut-kidney axis, with a focus on their contribution to uremic toxicity and clinical outcomes in hemodialysis patients. We explore how MPs, originating from endothelial cells, platelets, and gut microbiota, transport bioactive molecules, intensify inflammation, and impair endothelial function, thereby heightening cardiovascular risk. Furthermore, we assess their potential as biomarkers of disease severity and as novel therapeutic targets. By integrating current evidence, this review elucidates the intricate interplay between MPs, the gut-kidney axis, and uremic toxicity, offering fresh insights into improving outcomes for hemodialysis patients.
Core Tip: Microparticles (MPs) are increasingly recognized as pivotal mediators in the gut-kidney axis, particularly in hemodialysis patients. This review elucidates how gut dysbiosis triggers the release of host and microbial MPs, which transport uremic toxins and pro-inflammatory cargo to drive endothelial dysfunction and cardiovascular complications. By synthesizing current evidence on MP biogenesis and their role as biomarkers, we highlight novel therapeutic horizons, including microbiota modulation and MP-targeted interventions, aimed at disrupting this pathogenic dialogue to improve clinical outcomes in end-stage kidney disease.
