Probiotics may provide certain benefits to patients on dialysis but more research required
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Although patients on hemodialysis who received probiotics had decreases in idoxyl sulfate levels, researchers observed no benefits of supplementation on other studied measures, including insulin resistance and cholesterol-triglyceride ratio.
These findings led Paik Seong Lim, MD, PhD, of Tungs’ Taichung MetroHarbor Hospital in Taiwan, Republic of China, and colleagues to suggest more research be conducted regarding the effects of probiotics on patients with end-stage kidney disease.
“A rationale for the use of probiotics in patients on [hemodialysis] HD stems from reports of dysbiosis in the intestinal flora in [chronic kidney disease] CKD,” the researchers wrote. “The practical application of probiotic strategy has been especially encouraged by the positive results of some earlier studies in its use for modifying bacterial production of uremic toxins such as [idoxyl sulfate] IS and [p-cresyl sulfate] PCS. However, we are also aware that the results from individual studies investigating the effects of probiotic supplementation within the CKD population can yield discrepant results.”
With this in mind, the researchers sought to evaluate the impact of Lactobacillus-containing probiotic supplementation on the metabolic profile and body composition in patients who received hemodialysis, as well as to examine the efficacy of probiotics for decreasing uremic toxins, markers of inflammation and microbial translocation.
To do this, Lim and colleagues randomized 56 patients to receive either two probiotic sachets per day (6 grams each) or placebo for 6 months. The probiotic sachets contained a mixture of three strains and were prescribed at high dose (defined as 100 billion; 1 x 1011 cfu/day). Researchers noted treatment adherence was greater than 92%.
During 6 months of treatment, no changes were observed in either group for blood pressure, BMI, waist circumference, triglyceride, hemoglobin or fasting glucose levels; there were also no differences found regarding body composition.
Further findings indicated probiotic supplementation did not result in significant changes in hemoglobin levels, blood urea nitrogen, blood glucose, serum p-cresyl sulfate, inflammatory and microbial translocation markers, nor did it appear to have a significant influence on cholesterol-triglyceride ratio.
Lim and colleagues did, however, observe a statistically significant decrease in serum idoxyl sulfate levels for patients who received probiotic supplementation (55.06 at baseline vs. 34.52 after 6 months), a decrease which was not observed for those who received placebo. This reduction remained significant even after adjustment for age and diabetic status, according to researchers.
Lim and colleagues provided a theory as to why probiotics did not have an impact on most of the studied markers.
“This lack of effect may be a result of the altered gut microbial environment in patients on dialysis that negate the effect of high-dose, long-term probiotic supplementation,” they wrote. “In the future, well-designed and adequately powered trials across different stages of CKD and using high-dose multistrains of probiotics with prebiotics are needed to clarify its role in this specific population.”
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