Uremia coupled with mucosal damage predispose mice with kidney disease to systemic infection by commensal Candida albicans

Infections are the second major cause of mortality in patients with kidney disease and accompanying uremia. Both vascular access and non–access-related infections contribute equally to the infection-related deaths in patients with kidney disease. Dialysis is the most common cause of systemic infection by Candida albicans in these patients. C. albicans also reside in the gastrointestinal tract as a commensal fungus. However, the contribution of gut-derived C. albicans in non–access-related infections in kidney disease is unknown. Using a mouse model of kidney disease, we demonstrate that uremic animals showed increased gut barrier permeability, impaired mucosal defense, and dysbiosis. The disturbance in gut homeostasis is sufficient to drive the translocation of microbiota and intestinal pathogen Citrobacter rodentium to extraintestinal sites but not C. albicans. Interestingly, a majority of uremic animals showed fungal translocation only when the gut barrier integrity is disrupted. Our data demonstrate that uremia coupled with gut mucosal damage may aid in the translocation of C. albicans and cause systemic infection in kidney disease. Because most of the individuals with kidney disease suffer from some form of gut mucosal damage, these results have important implications in the risk stratification and control of non–access-related opportunistic fungal infections in these patients.