Administration of biotics can benefit patients with CKD
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Biotic supplementation “favorably influences” circulating markers of oxidant stress inflammation and some uremic toxins in patients with chronic kidney disease, according to data published in the Journal of Renal Nutrition.
Previous studies have suggested that biotic supplementation can improve symptoms of CKD, resulting in a lowered risk for kidney damage. However, the effects of this treatment remain controversial, and most randomized clinical trials only observe limited populations.
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In a meta-analysis, Jing Liu, MD, and colleagues searched for randomized controlled trials assessing any biotic (prebiotic, probiotic, synbiotic) supplements in patients with CKD (CKD, stage 3-4 to end-stage renal disease) to find benefits of treating patients with CKD, across a range of kidney dysfunction, with biotics. All studies came from PubMed, Embase or Cochrane databases.
The study’s primary endpoint was any change in renal function, markers of inflammation or oxidative stress. Researchers also looked for changes in levels of uremic toxins and shifts in lipid metabolism.
Researchers found 23 eligible studies with a total of 842 participants. A pooled analysis revealed that biotics did not change estimated glomerular filtration rate (mean difference = 0.08, P = .92) or serum albumin (mean difference = –0.01, P = .86). However, prebiotics decreased serum creatinine (standardized mean difference [SMD] = –0.23, P = .009) and blood urea nitrogen (mean difference = – 6.05, P < .00001).
Similarly, biotics improved total antioxidative capacity (SMD = 0.37, P = .007), malondialdehyde (SMD = –0.96, P = .006) and the inflammatory marker interleukin-6 (SMD = –0.30, P = .01) but not C-reactive protein (SMD = –0.22, P = .20). Biotic intervention reduced some uremic toxins, including p-cresol sulfate (SMD = –2.18, P = .0001) and indoxyl sulfate (mean difference = –5.14, P = .0009).
“Biotics supplementation reduces circulating several markers of oxidant stress (malondialdehyde, total antioxidative capacity) and inflammation (interleukin-6) in predialysis CKD as well as in end-stage renal disease patients requiring dialysis,” Liu and colleagues wrote. “However, biotics do not affect estimated glomerular filtration rate, creatinine, albumin, lipids [nor] other uremic toxins (p-cresol sulfate, indole-3-acetic acid). Studies of longer period and with larger scales are advocated to further understand the relationship between biotics and renal disease.”
The study’s limitations include a small sample size and short durations of follow-up periods. Additionally, the researchers noted that future studies should consider free concentration of uremic toxins.
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