The impact of synbiotic treatment on the levels of gut-derived uremic toxins, inflammation, and gut microbiome of chronic kidney disease patients- A randomized trial.

Study answer

What this study found

Synbiotic treatment enriched gut microbiota (Bifidobacteria, Lactobacillus, Subdoligranulum) and reduced serum indoxyl sulfate; eGFR improved (12% vs 8% in placebo); hsCRP decreased (−39.5% vs −8.5%). Intention-to-treat analyses showed IS dynamics −14.6% vs 5.3% (P=0.002) and TMAO dynamics −5.3% vs 1.6% (P=0.039). The treatment was generally safe; two intervention participants reported increased flatulence. Conclusion: Synbiotics could be a safe and effective strategy to lower gut-derived uremic toxins and microinflammation in CKD and may be used in daily practice.

Study & population

Single-center, randomized, double-blind, placebo-controlled trial in nondialyzed CKD patients aged 18 years or older with eGFR 15-45 mL/min; 34 participants randomized (17 per group).

Intervention

Two capsules daily, before breakfast, for 12 weeks; each capsule contains Lactobacillus acidophilus CBTLA1 (16e9 CFU), Lactobacillus casei CBT LC5 (4e9 CFU), Bifidobacterium lactis CBT BL3 (8e9 CFU), and 1.6 g inulin.

Key limitation

Small, single-center randomized trial (n=34); short duration (12 weeks); per-protocol analyses with some dropouts; limited generalizability and power; safety data limited to short term.

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Original abstract