Probiotics, Prebiotics, and Synbiotics Improve Uremic, Inflammatory, and Gastrointestinal Symptoms in End-Stage Renal Disease With Dialysis: A Network Meta-Analysis of Randomized Controlled Trials

Network meta-analysis of 25 randomized controlled trials including 1,106 adults with end-stage renal disease undergoing dialysis. Included participants were adults aged at least 18 years, with mean ages across studies ranging from 28.84 to 71.20 years.

Probiotics, prebiotics, and synbiotics were compared with placebo in randomized trials of adults with end-stage renal disease undergoing dialysis. Specific doses, formulations, frequency, and duration were not reported in the provided source packet.

The supplement strategies showed benefits, with different products ranking best for different outcomes. Prebiotics were superior for IL-6 (SMD -0.74; 95% CI [-1.32, -0.16]), TNF-α (SMD -0.59; 95% CI [-1.09, -0.08]), indoxyl sulfate (SMD -0.43; 95% CI [-0.81, -0.05]), blood urea nitrogen (SMD -0.42; 95% CI [-0.78, -0.06]), and malondialdehyde (SMD -1.88; 95% CI [-3.02, -0.75]). Synbiotics were best for C-reactive protein (SMD -0.69; 95% CI [-1.14, -0.24]) and endotoxin (SMD -0.83; 95% CI [-1.38, -0.27]), while probiotics were most effective for gastrointestinal symptoms (GSRS; SMD -0.52; 95% CI [-0.93, -0.1]). Creatinine, urea, and uric acid were not significantly decreased by any supplement.

The evidence base included only a small number of multi-arm trials, and the included studies were heterogeneous. Outcome timing and measurement details were not specified in the provided text, and adverse events were not described. Arm-specific demographic and dietary data were limited or unavailable, which restricts interpretation and generalizability.