Abstract: Diet-based choline is metabolized by gut microbes to produce trimethylamine oxide (TMAO), which is an independent risk factor for the progression of major diseases such as cardiovascular disease, chronic kidney disease (CKD), and type 2 diabetes. TMAO is excreted in the human body mainly by glomerular filtration and renal tubule secretion. Decreased renal function can lead to increased circulating TMAO concentration, induce atherosclerosis, increase the risk of stroke, promote inflammatory response and oxidative stress, and lead to myocardial and renal interstitial fibrosis. Sodium-glucose transporter 2 inhibitors and incretin can change the circulating TMAO concentration, and the effect on the primary disease remains to be determined. In addition to adjusting diet, targeted TMAO therapeutics such as probiotics or prebiotics, trimethylamine (TMA) inhibitors, and flavin monooxygenase 3 (FMO3) inhibitors can affect intestinal TMAO production to varying degrees, but the exact impact on body of the host and the course of CKD still needs further study. This review summaries the researching development progress of targeting TMAO drugs,such as regulating the composition of the gut microbiota and reduce the metabolic production of TMA levels by probiotics or prebiotics, inhibiting TMA producing bacteria from producing TMAO by TMA inhibitors, to provide theoretical basis for their use as new treatment strategies of CKD.

Key words: chronic kidney disease, trimethylamin N-oxide, treatment