Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis
We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients.
A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137.
Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2 months after treatment) with standardized mean difference (SMD) of − 0.42 (95% CI − 0.68 to − 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of − 0.37 (95% CI − 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of − 0.32 (95% CI − 0.92 to 0.28, p = 0.29) and 0.16 (95% CI − 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of − 0.61 (95% CI − 1.16 to − 0.07, p = 0.03) and − 1.04 (95% CI − 1.70 to − 0.38, p = 0.002), respectively.
Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.
KeywordsProbiotics Gut microbiome End-stage renal disease ESRD Dialysis Uremic toxins
All authors had access to the data and a role in writing the manuscript.
Compliance with ethical standards
Conflict of interest
We do not have any financial or non-financial potential conflicts of interest.
- 1.NIH. Kidney Disease Statistics for the United States. 2016. Available at: https://www.niddk.nih.gov/health-information/health-statistics/kidney-disease. Accessed December 20, 2017.
- 3.USRDS U. Annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2013. https://www.usrds.org/2013/pdf/v1_00_intro_13.pdf. Accessed December 20, 2017.
- 9.Di Iorio BR, Marzocco S, Nardone L, et al. Urea and impairment of the gut-kidney axis in chronic kidney disease. G Ital Nefrol. 2017;34:19.Google Scholar
- 27.Schwenger EM, Tejani AM, Loewen PS. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. 2015;12:CD008772.Google Scholar
- 35.Dehghani H, Heidari F, Mozaffari-Khosravi H, Nouri-Majelan N, Dehghani A. Synbiotic supplementations for azotemia in patients with chronic kidney disease: a randomized controlled trial. Iran J Kidney Dis. 2016;10:351–357.Google Scholar
- 54.Miranda Alatriste PV, Urbina Arronte R, Gomez Espinosa CO, Espinosa Cuevas MDLA. Effect of probiotics on human blood urea levels in patients with chronic renal failure. Nutr Hosp. 2014;29:582–590.Google Scholar
- 55.Pavan M. Influence of prebiotic and probiotic supplementation on the progression of chronic kidney disease. Minerva Urol Nefrol. 2016;68:222–226.Google Scholar
- 68.Simenhoff ML, Dunn SR, Zollner GP, et al. Biomodulation of the toxic and nutritional effects of small bowel bacterial overgrowth in end-stage kidney disease using freeze-dried Lactobacillus acidophilus. Miner Electrolyte Metab. 1996;22:92–96.Google Scholar
- 70.Natarajan R, Pechenya B. Randomized controlled trial of strain-specific probiotic formulation (Renadyl) in dialysis patients. BioMed Res Int. 2014;2014:568571.Google Scholar
- 72.Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions. Hoboken: Wiley; 2011.Google Scholar
- 90.Corbitt M, Campagnolo N, Staines D, Marshall-Gradisnik S. A systematic review of probiotic interventions for gastrointestinal symptoms and irritable bowel syndrome in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Probiotics Antimicrob Proteins. 2018. https://doi.org/10.1007/s12602-018-9397-8.Google Scholar
- 92.Natarajan R, Pechenyak B, Vyas U, et al. Randomized controlled trial of strain-specific probiotic formulation (Renadyl) in dialysis patients. Biomed Res Int. 2014;2014:568571.Google Scholar