Efficacy of Probiotics Supplementation On Chronic Kidney Disease: a Systematic Review and Meta-Analysis

Kidney and Blood Pressure Research
Q2
Oct 2018
Citations:65
Influential Citations:2
Systematic Reviews / Meta-Analyses
87
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Enhanced Details

Methods
Eight randomized controlled trials enrolling 261 adults with CKD stages 3–5, with and without dialysis; three cross-over designs; treatment durations 1–6 months; probiotic regimens varied by strain and dose; age and sex reported variably; risk of bias assessed with Cochrane tool; evidence quality mostly low to very low.
Intervention
Multi-strain probiotic regimens delivered orally daily for 1–6 months; daily doses ranged from 4 to 180 billion CFU; regimens varied by study and included combinations such as Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus casei subsp. rhamnosus, Streptococcus thermophilus, Lactobacillus salivarius, Lactobacillus sporogenes, and Bifidobacterium spp. Some trials used synbiotics (probiotic plus prebiotic such as oligofructose-enriched inulin or Lactobacillus casei Shirota with Bifidobacterium breve).
Results
PCS decreased in probiotics groups in three studies (n=125): P=0.01; SMD −0.57; 95% CI −0.99 to −0.14; I2=25%. IL-6 increased in three studies (n=134): P=0.03; SMD 0.37; 95% CI 0.03 to 0.72; I2=0%. Scr, BUN, CRP, Hb showed no significant changes. Conclusion: limited, small trials; probiotics may reduce PCS and increase IL-6, suggesting potential intestinal barrier benefit, but no proven improvement in renal function; more high-quality trials are needed.
Limitations
Small number of trials (n=8) with 261 participants; short durations (1–6 months); heterogeneity in strains/doses and dialysis status; risk of bias in several trials; inconsistent reporting/baseline comparability; overall evidence quality low.

Abstract

Background/Aims: Dysbiosis of the intestinal microbiota may accelerate the progression of chronic kidney disease (CKD) by increasing the levels of urea toxins. In recent years, probiotics have been recognized to maintain the physiological balance of ...