**5. Conclusions and Perspectives**

Mounting evidence in support of the link between gut microbiota and CKD starting in early life is intriguing but incomplete. One major unsolved problem is the gap in published child- and adult-focused clinical CKD research. Most pediatric CKD studies have limited power due to a small sample size. Although substantial evidence indicates an association between gut microbiota and CKD in adult patients with different stages of CKD and/or various comorbidities, we still lack such information in the pediatric population. Therefore, future work in large multicenter studies regarding CKD and its comorbidities is required to enable the establishment of more robust true relationships in the pediatric population.

Prior research has indicated that the early-life gut microbiome might influence renal programming and exert CKD in later life. Our review highlights the value of gut microbiotatargeted therapies, if applied early, to help prevent CKD and its related complications. Nevertheless, many probiotics and prebiotics used in adult CKD have not been examined in childhood CKD yet, especially in CKD of developmental origins.

In conclusion, gut microbiota dysbiosis is a highly pathogenetic link in the development of CKD and its comorbidities. After all of this significant growth in understanding of the gut microbiota in the pathophysiology of pediatric CKD and its targeted interventions, it may open new avenues for prevention of CKD in childhood or even earlier in fetal life.

**Author Contributions:** Conceptualization, C.-N.H. and Y.-L.T.; funding acquisition, C.-N.H. and Y.- L.T.; project administration, C.-N.H. and Y.-L.T.; data curation, C.-N.H. and Y.-L.T.; writing—original draft, C.-N.H. and Y.-L.T.; writing—review and editing, C.-N.H. and Y.-L.T. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by grants MOST 110-2314-B-182-020-MY3 (Y.-L.T.) and MOST 110-2314-B-182A-029 (C.-N.H.) from the Ministry of Science and Technology, Taiwan, and the grants CORPG8M0081 and CORPG8M0151 from Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** All data are contained within the article.

**Conflicts of Interest:** The authors declare no conflict of interest.
