Patients who suffer from chronic kidney disease (CKD) often have abnormal gut flora. CKD and dysbiotic gut have bidirectional relationship, whereby one causes the other and the other way around. In dysbiotic gut there is lower number of beneficial bacteria which produce short chain fatty acids, which are essential nutrient for colonic ephitilium. On the other hand, there is also increased number of those bacteria which produce uremic toxins, such as TMAO, indoxy sulphate, p-cresyl sulphate and others. Because of gut inflamation and degredation of proteins that make zonae ocludens there is translocation of these toxins in system circulation where they produce effects on number of organ systems, including kidneys, where they promote kidney fibrosis. High levels of these uremic toxins correlate with higher incidence of cardiovascular events, which are the most common causes of death in CKD patiens, as well as overall mortality. Because of its plasticity, gut microbiota can be called manipulative „organ“. There are several ways which are suggested in manipulation with these „organ“. Those are: nutrition interventions, prebiotics and probiotics, activeted charcoal and some new methods like transplantation of fecal microbiota or use of „smart“ bacteria. In order to better understand the role of the intestinal microbiota in health and disease, even more basic and clinical research is needed