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

Systematic review and meta-analysis of 8 randomized controlled trials in adults with chronic kidney disease stages 3 to 5, including both non-dialysis patients and patients receiving hemodialysis or peritoneal dialysis. The review pooled outcomes from active probiotic arms across heterogeneous probiotic formulations and follow-up durations.

Oral probiotic supplementation was tested in multiple formulations, mainly multi-strain Lactobacillus and Bifidobacterium products, sometimes with Streptococcus thermophilus. Daily doses ranged from 4 billion to 180 billion CFU and treatment durations ranged from 3 weeks to 3 months, compared with placebo or control conditions across the included trials.

Probiotics modestly improved the uremic toxin p-cresyl sulfate, but did not improve kidney function, blood urea nitrogen, hemoglobin, or C-reactive protein. For p-cresyl sulfate, 3 studies contributed data (N_probiotics=65; N_placebo=60) and the pooled effect favored probiotics (SMD -0.57, 95% CI -0.99 to -0.14; P=0.01; I2 = 25%). For IL-6, 3 studies (N_probiotics=134) showed a significant increase (P=0.03; 95% CI 0.03 to 0.72; I2 = 0%). Serum creatinine (P = 0.47; 95% CI -0.13 to 0.28), BUN (P = 0.73; 95% CI -9.26 to 6.50), Hb (P = 0.49), and CRP (P = 0.49; 95% CI -6.45 to 3.11; I2 = 28%) were not significantly changed. Adverse events were infrequently reported and the overall intervention was described as relatively safe.

The evidence base was small, with only 8 trials and limited participants contributing to each outcome. Probiotic products, doses, and treatment durations varied substantially, and overall evidence quality was low to very low. Adverse-event reporting was incomplete, and several studies had small sample sizes and short follow-up.