The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
What this study found
Concludes that oral prebiotic, probiotic, and synbiotic supplementation may reduce circulating endotoxin, indoxyl-sulphate and p-cresyl-sulphate in dialysis-dependent ESRD and improve gastrointestinal symptoms, with no apparent safety concerns. However, evidence is limited by high risk of bias and small, heterogeneous trials; larger, well-designed randomized trials are needed to confirm benefits and to evaluate cardiovascular outcomes.
- Study & population
- Adults (>18 years) with end-stage renal disease receiving haemodialysis or peritoneal dialysis; randomized controlled trials (parallel-group or crossover).
- Intervention
- Oral regimens of prebiotic, probiotic, or synbiotic supplements; dosage not specified; duration 2–24 weeks.
- Key limitation
- Many trials had moderate-to-high risk of bias (allocation concealment/blinding issues); small sample sizes; short duration; heterogeneity across outcomes; limited adverse event reporting; data for some outcomes not consistently reported.
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Open PDFOriginal abstract
OBJECTIVE This systematic review and meta-analyses provide an up-to-date synthesis on the effects of supplementation on circulating levels of toxic metabolites, markers of uremia and inflammation, blood lipids, and other clinical outcomes. METHODS Seventeen databases were searched, supplemented with internet and hand searching. Randomized controlled trials of adult end-stage renal-disease individuals receiving either hemodialysis or peritoneal dialysis were eligible. Trials were restricted to those which had administered a prebiotic, probiotic, or synbiotic as an oral supplement. Primary outcomes were measures of circulating endotoxin, indoxyl-sulphate, and p-cresyl sulfate. RESULTS Twenty-one trials were eligible (1152 randomized participants), of which 16 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesized data indicated that supplementation significantly reduced circulating levels of endotoxin (standardized mean difference, -0.61; 95% confidence interval, -1.03 to -0.20; P = .004; I2 = 0%), indoxyl-sulphate (-0.34; -0.64 to -0.04; P = .02; I2 = 0%), and p-cresyl sulfate (-0.34; -0.61 to -0.07; P = .01; I2 = 0%). For secondary outcomes, supplementation significantly reduced gastrointestinal symptoms (-0.54; -1.02 to -0.07; P = .02; I2 = 0%). CONCLUSIONS Supplementation reduces toxic metabolites associated with cardiovascular disease and mortality in individuals receiving dialysis. However, the majority of trials included were low in quality.