BOSTON, January 18, 2026 – Disruptions in how the body processes bile acids may be a surprisingly important, yet overlooked, factor in the progression of chronic kidney disease (CKD), new research suggests. It’s a twist-we frequently enough focus on toxins *building up* in kidney disease, but what if how we process everyday substances is also going wrong?
This study reveals altered bile acid patterns in advanced CKD, potentially opening new avenues for treatment.
- Researchers found patients with advanced CKD had different levels of bile acids in their blood and urine compared to those with healthy kidneys.
- Levels of sulfate-conjugated bile acids were considerably higher in CKD patients, while unconjugated bile acids were lower.
- Specific bile acids correlate with lower kidney function (eGFR).
Researchers compared bile acid profiles in 29 individuals with advanced CKD and 30 age- and sex-matched individuals with normal kidney function.
Sulfate-Conjugated Bile Acids Rise in Kidney Disease
While overall bile acid levels in the blood didn’t differ significantly between the two groups, the *composition* of those bile acids did. Patients with CKD had notably lower levels of unconjugated bile acids and substantially higher levels of sulfate-conjugated bile acids. This suggests the kidneys aren’t processing or clearing bile acids as efficiently as they should be.
Interestingly, urine tests showed a marked *reduction* in bile acid excretion in CKD patients. Total urinary bile acid levels, and most individual types, were significantly lower, indicating impaired kidney handling of these metabolites.
What dose this mean for your kidneys? Higher levels of specific bile acids-ursodeoxycholic acid, chenodeoxycholic acid, and sulfate-conjugated bile acids-were independently linked to a lower estimated glomerular filtration rate (eGFR), a measure of kidney function. this connection remained even after researchers adjusted for factors like age, sex, and diabetes.
Implications for Future Research
The study, published in Nephrology on january 18, 2026, acknowledges its limitations-a relatively small sample size and its cross-sectional design (meaning it captures a single point in time). However, it provides valuable new insights into bile acid imbalances in CKD. The researchers propose that analyzing bile acid profiles could help unravel the underlying mechanisms of the disease and potentially identify new therapeutic targets focused on modulating the gut-kidney connection.
The authors concluded that while total serum bile acid levels may not change, the way the body processes and modifies these acids is significantly altered in advanced CKD, supporting the idea that disrupted bile acid metabolism contributes to kidney disease progression.
What other factors might be at play? Further research is needed to determine if manipulating bile acid metabolism could slow the progression of CKD.
