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
What this study found
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%…
- Study & population
- Network meta-analysis of 25 randomized controlled trials including 1,106 adults with end-stage renal disease undergoing dialysis.
- Intervention
- Probiotics, prebiotics, and synbiotics were compared with placebo in randomized trials of adults with end-stage renal disease undergoing dialysis.
- Key limitation
- The evidence base included only a small number of multi-arm trials, and the included studies were heterogeneous.
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Open PDFOriginal abstract
Background Probiotics, prebiotics, and synbiotics are three different supplements to treat end stage renal disease (ESRD) patients by targeting gut bacteria. The comprehensive comparison of the effectiveness of different supplements are lacking. Objectives The purpose of this network meta-analysis (NMA) is to assess and rank the efficacy of probiotics, prebiotics, and synbiotics on inflammatory factors, uremic toxins, and gastrointestinal symptoms (GI symptoms) in ESRD patients undergoing dialysis. Methods Randomized clinical trials were searched from the PubMed, Embase, and Cochrane Register of Controlled Trials databases, from their inception until 4 September 2021. Random-effect model were used to obtain all estimated outcomes in network meta-analysis (NMA). Effect estimates were presented as mean differences (Mean ± SD) with 95% confidence interval (CI). The comprehensive effects of all treatments were ranked by the surface under the cumulative ranking (SUCRA) probabilities. Results Twenty-five studies involved 1,106 participants were included. Prebiotics were superior in decreasing Interleukin-6 (IL-6; SMD –0.74, 95% CI [–1.32, –0.16]) and tumor-necrosis factor-α (TNF-α; SMD –0.59, 95% CI [–1.09, –0.08]), synbiotics were more effective in declining C-reactive protein (CRP; SMD –0.69, 95% CI [–1.14, –0.24]) and endotoxin (SMD –0.83, 95% CI [–1.38, –0.27]). Regarding uremic toxins, prebiotics ranked highest in reducing indoxyl sulfate (IS; SMD –0.43, 95% CI [–0.81, –0.05]), blood urea nitrogen (BUN; SMD –0.42, 95% CI [–0.78, –0.06]), and malondialdehyde (MDA; SMD –1.88, 95% CI [–3.02, –0.75]). Probiotics were rated as best in alleviating GI symptoms (SMD: –0.52, 95% CI [–0.93, –0.1]). Conclusion Our research indicated prebiotics were more effective in declining IL-6, TNF-α, IS, MDA, and BUN, synbiotics lowering CRP and endotoxin significantly, and probiotics were beneficial for alleviating GI symptoms, which may contribute to better clinical decisions. This study was registered in PROSPERO (Number: CRD42021277056). Systematic Review Registration [http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021277056].