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(60), which can lead to microbial translocation, systemic inflammation, and increased permeability of both the intestinal and blood-brain barriers (BBB), creating a vicious cycle (6165)

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Moreover, the KYN pathway, which is altered in both depression and CKD, has been implicated in gut permeability and immune dysregulation, further linking the gut-brain axis with kidney dysfunction (Kearns, 2024)