Effects of Probiotics, Prebiotics, and Synbiotics on Uremic Toxins, Inflammation, and Oxidative Stress in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
What this study found
Probiotic, prebiotic, or synbiotic supplementation significantly reduced circulating p-cresyl sulfate (p-CS) and endotoxins, and improved oxidative stress markers (TAC up, GSH up, MDA down) and inflammatory markers (CRP, IL-6) versus control. IS reduction was not consistently significant. Authors conclude these supplements can favorably modulate gut-derived toxins, inflammation, and oxidative balance in hemodialysis patients, potentially contributing to better health outcomes; however, substantial heterogeneity and regimen differences limit specific clinical recommendations. More…
- Study & population
- Adults with end-stage renal disease on maintenance hemodialysis; randomized controlled trials (including parallel and crossover); 931 participants across 23 trials; mean ages ranged 32–63 years.
- Key limitation
- Significant heterogeneity across trials; diverse probiotic/prebiotic/synbiotic strains, doses, and durations; incomplete reporting of participant demographics; some risk-of-bias concerns; inability to isolate effects by supplement type; short-term trials with no long-term outcomes.
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Open PDFOriginal abstract
The dysbiosis of gut microbiota may cause many complications in patients with end-stage renal disease, which may be alleviated by probiotic, prebiotic, and synbiotic supplementation. The aim of this systematic review and meta-analysis was to assess the effects of these supplementations on circulatory uremic toxins, biomarkers of inflammation, and oxidative stress in hemodialysis patients. We searched the EMBASE, MEDLINE, Web of Science, and Cochrane Library databases until 8 August 2021. Randomized controlled trials evaluating adult patients receiving hemodialysis were included. The pooled results from 23 studies with 931 hemodialysis patients indicated that interventions significantly decreased the circulating levels of p-cresyl sulfate (standardized mean difference (SMD): 0.38; 95% CI: −0.61, −0.15; p = 0.001), endotoxins (SMD: −0.58; 95% CI: −0.99, −0.18; p = 0.005), malondialdehyde (SMD: −1.16; 95% CI: −1.81, −0.52; p = 0.0004), C-reactive proteins (CRP) (SMD: −0.61; 95% CI: −0.99, −0.23; p = 0.002), and interleukin 6 (SMD: −0.92; 95% CI: −1.51, −0.33; p = 0.002), and improved the total antioxidant capacity (SMD: 0.89; 95% CI: 0.49, 1.30; p < 0.0001) and glutathione (SMD: 0.40; 95% CI: 0.14, 0.66; p = 0.003) when compared to the placebo group. Our results suggest that treatment with probiotics, prebiotics, and synbiotics may help alleviate uremic toxin levels, oxidative stress, and the inflammatory status in hemodialysis patients.