Increased levels of oral Streptococcus-derived d-alanine in patients with chronic kidney disease and diabetes mellitus

The number of patients on hemodialysis is increasing globally; diabetes mellitus (DM) complications is the major cause of hemodialysis in patients with chronic kidney disease (CKD). The d-amino acid (AA) profile is altered in patients with CKD; however, it has not been studied in patients with CKD and DM. Furthermore, bacteria responsible for altering the D-AA profile are not well understood. Therefore, we examined the D-AA profiles and associated bacteria in patients with CKD, with and without DM. We enrolled 12 healthy controls and 54 patients with CKD, with and without DM, and determined their salivary, stool, plasma, and urine chiral AA levels using two-dimensional high-performance liquid chromatography. We performed 16S rRNA gene sequencing analysis of the oral and gut microbiota to determine the association between the abundance of bacterial species and D-AA levels. Plasma d-alanine and d-serine levels were higher in patients with CKD than in healthy adults (p < 0.01), and plasma d-alanine levels were higher in patients with CKD and DM than in those without DM. The abundance of salivary Streptococcus, which produced d-alanine, increased in patients with CKD and DM and was positively correlated with plasma d-alanine levels. Patients with CKD and DM had unique oral microbiota and d-alanine profiles. Plasma d-alanine is a potential biomarker for patients with CKD and DM.