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Probiotics, Prebiotics, and Synbiotics for Patients on Dialysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Published:April 19, 2022DOI:https://doi.org/10.1053/j.jrn.2022.04.001

      Objective

      The current systematic review and meta-analysis investigated the effects of probiotic, prebiotic, and synbiotic administration on inflammation, metabolic parameters, nutritional status, and uremic toxin in dialysis patients.

      Methods

      Up to June 2021, publications were searched in Cochrane Library, PubMed, EMBASE, and Web of Science databases. The protocol was submitted to the International Prospective Register of Systematic Reviews and was approved.

      Results

      This meta-analysis included 18 randomized controlled trials which were eligible. This meta-analysis discovered that probiotic, prebiotic, and synbiotic supplements could reduce C-reactive protein (standardized mean difference (SMD), −0.38; 95% confidence interval (CI), −0.68 to −0.08; P = .01), interleukin 6 (SMD, −0.48; 95% CI, −0.76 to −0.20; P = .00), and indoxyl sulfate (SMD, −0.24; 95% CI, −0.48 to −0.01; P = .045) and increase high-density lipoprotein cholesterol (SMD, 0.25; 95% CI, 0.03 to 0.46; P = .025) compared with the control group but had no significant influence on tumor necrosis factor α, albumin, hemoglobin, triglyceride, total cholesterol, low-density lipoprotein cholesterol, calcium, phosphorus, uric acid, or p-cresyl sulfate in dialysis patients.

      Conclusions

      Probiotic, prebiotic, and synbiotic administration could reduce C-reactive protein, interleukin 6, and indoxyl sulfate and increase high-density lipoprotein cholesterol in dialysis patients. To better examine the impact, large-scale, long-term, controlled diets and well-designed randomized controlled trials are needed.

      Keywords

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      References

      1. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.
        Lancet. 2020; 395: 709-733
        • Zhang L.
        • Wang F.
        • Wang L.
        • et al.
        Prevalence of chronic kidney disease in China: a cross-sectional survey.
        Lancet. 2012; 379: 815-822
        • Zha Y.
        • Qian Q.
        Protein nutrition and malnutrition in CKD and ESRD.
        Nutrients. 2017; 9: 208
        • Cobo G.
        • Lindholm B.
        • Stenvinkel P.
        Chronic inflammation in end-stage renal disease and dialysis.
        Nephrol Dial Transpl. 2018; 33: iii35-iii40
        • Ferro C.J.
        • Mark P.B.
        • Kanbay M.
        • et al.
        Lipid management in patients with chronic kidney disease.
        Nat Rev Nephrol. 2018; 14: 727-749
        • Levin A.
        • Bakris G.L.
        • Molitch M.
        • et al.
        Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease.
        Kidney Int. 2007; 71: 31-38
        • Ikee R.
        • Sasaki N.
        • Yasuda T.
        • Fukazawa S.
        Chronic kidney disease, gut dysbiosis, and constipation: aBurdensome Triplet.
        Microorganisms. 2020; 8: 1862
        • Rysz J.
        • Franczyk B.
        • Ławiński J.
        • et al.
        The impact of CKD on uremic toxins and gut microbiota.
        Toxins (Basel). 2021; 13: 252
        • Chow J.
        Probiotics and prebiotics: a brief overview.
        J Ren Nutr. 2002; 12: 76-86
        • Tsai Y.L.
        • Lin T.L.
        • Chang C.J.
        • et al.
        Probiotics, prebiotics and amelioration of diseases.
        J Biomed Sci. 2019; 26: 3
        • Wieërs G.
        • Belkhir L.
        • Enaud R.
        • et al.
        How probiotics affect the microbiota.
        Front Cell Infect Microbiol. 2019; 9: 454
        • Holscher H.D.
        Dietary fiber and prebiotics and the gastrointestinal microbiota.
        Gut Microbes. 2017; 8: 172-184
        • Markowiak P.
        • Śliżewska K.
        Effects of probiotics, prebiotics, and synbiotics on Human health.
        Nutrients. 2017; 9: 1021
        • de Andrade L.S.
        • Sardá F.A.H.
        • Pereira N.B.F.
        • et al.
        Effect of Unripe Banana Flour on gut-derived uremic toxins in individuals undergoing peritoneal dialysis: arandomized, double-blind, placebo-controlled, crossover trial.
        Nutrients. 2021; 13: 646
        • Pan Y.
        • Yang L.
        • Dai B.
        • et al.
        Effects of probiotics on malnutrition and health-related quality of Life in patients undergoing peritoneal dialysis: arandomized controlled trial.
        J Ren Nutr. 2021; 31: 199-205
        • Viramontes-Hörner D.
        • Márquez-Sandoval F.
        • Martín-del-Campo F.
        • et al.
        Effect of a symbiotic gel (Lactobacillus acidophilus + Bifidobacterium lactis + inulin) on presence and severity of gastrointestinal symptoms in hemodialysis patients.
        J Ren Nutr. 2015; 25: 284-291
        • Soleimani A.
        • Motamedzadeh A.
        • Zarrati Mojarrad M.
        • et al.
        The effects of synbiotic supplementation on metabolic status in diabetic patients undergoing hemodialysis: a randomized, double-blinded, placebo-controlled trial.
        Probiotics Antimicrob Proteins. 2019; 11: 1248-1256
        • Liu T.
        • Wang X.
        • Li R.
        • et al.
        Effects of probiotic Preparations on inflammatory cytokines in chronic kidney disease patients: asystematic review and meta-analysis.
        Curr Pharm Biotechnol. 2021; 22: 1338-1349
        • Zheng H.J.
        • Guo J.
        • Wang Q.
        • et al.
        Probiotics, prebiotics, and synbiotics for the improvement of metabolic profiles in patients with chronic kidney disease: a systematic review and meta-analysis of randomized controlled trials.
        Crit Rev Food Sci Nutr. 2021; 61: 577-598
        • Pisano A.
        • D'Arrigo G.
        • Coppolino G.
        • Bolignano D.
        Biotic supplements for renal patients: asystematic review and meta-analysis.
        Nutrients. 2018; 10
        • Simões-Silva L.
        • Araujo R.
        • Pestana M.
        • Soares-Silva I.
        • Sampaio-Maia B.
        The microbiome in chronic kidney disease patients undergoing hemodialysis and peritoneal dialysis.
        Pharmacol Res. 2018; 130: 143-151
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        Bmj. 2003; 327: 557-560
        • Li L.
        • Xiong Q.
        • Zhao J.
        • et al.
        Inulin-type fructan intervention restricts the increase in gut microbiome-generated indole in patients with peritoneal dialysis: a randomized crossover study.
        Am J Clin Nutr. 2020; 111: 1087-1099
        • Wang I.K.
        • Wu Y.Y.
        • Yang Y.F.
        • et al.
        The effect of probiotics on serum levels of cytokine and endotoxin in peritoneal dialysis patients: a randomised, double-blind, placebo-controlled trial.
        Benef Microbes. 2015; 6: 423-430
        • Borges N.A.
        • Carmo F.L.
        • Stockler-Pinto M.B.
        • et al.
        Probiotic supplementation in chronic kidney disease: adouble-blind, randomized, placebo-controlled trial.
        J Ren Nutr. 2018; 28: 28-36
        • Eidi F.
        • Poor-Reza Gholi F.
        • Ostadrahimi A.
        • et al.
        Effect of Lactobacillus Rhamnosus on serum uremic toxins (phenol and P-Cresol) in hemodialysis patients: a double blind randomized clinical trial.
        Clin Nutr ESPEN. 2018; 28: 158-164
        • Haghighat N.
        • Mohammadshahi M.
        • Shayanpour S.
        • Haghighizadeh M.H.
        Effect of synbiotic and probiotic supplementation on serum levels of Endothelial cell Adhesion molecules in hemodialysis patients: a randomized control study.
        Probiotics Antimicrob Proteins. 2019; 11: 1210-1218
        • Haghighat N.
        • Mohammadshahi M.
        • Shayanpour S.
        • Haghighizadeh M.H.
        Effects of synbiotics and probiotics supplementation on serum levels of endotoxin, Heat Shock protein 70 Antibodies and inflammatory Markers in hemodialysis patients: a randomized double-blinded controlled trial.
        Probiotics Antimicrob Proteins. 2020; 12: 144-151
        • Kooshki A.
        • Tofighiyan T.
        • Miri M.
        A synbiotic supplement for inflammation and oxidative stress and lipid abnormalities in hemodialysis patients.
        Hemodial Int. 2019; 23: 254-260
        • Lim P.S.
        • Wang H.F.
        • Lee M.C.
        • et al.
        The efficacy of Lactobacillus-containing probiotic supplementation in hemodialysis patients: arandomized, double-blind, placebo-controlled trial.
        J Ren Nutr. 2021; 31: 189-198
        • Mirzaeian S.
        • Saraf-Bank S.
        • Entezari M.H.
        • et al.
        Effects of synbiotic supplementation on microbiota-derived protein-bound uremic toxins, systemic inflammation, and biochemical parameters in patients on hemodialysis: a double-blind, placebo-controlled, randomized clinical trial.
        Nutrition. 2020; 73: 110713
        • Natarajan R.
        • Pechenyak B.
        • Vyas U.
        • et al.
        Randomized controlled trial of strain-specific probiotic formulation (Renadyl) in dialysis patients.
        Biomed Res Int. 2014; 2014: 568571
        • Shariaty Z.
        • Mahmoodi Shan G.R.
        • Farajollahi M.
        • Amerian M.
        • Behnam Pour N.
        The effects of probiotic supplement on hemoglobin in chronic renal failure patients under hemodialysis: a randomized clinical trial.
        J Res Med Sci. 2017; 22: 74
        • Sirich T.L.
        • Plummer N.S.
        • Gardner C.D.
        • Hostetter T.H.
        • Meyer T.W.
        Effect of increasing dietary fiber on plasma levels of colon-derived solutes in hemodialysis patients.
        Clin J Am Soc Nephrol. 2014; 9: 1603-1610
        • Soleimani A.
        • Zarrati Mojarrad M.
        • Bahmani F.
        • et al.
        Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects.
        Kidney Int. 2017; 91: 435-442
        • Tayebi Khosroshahi H.
        • Vaziri N.D.
        • Abedi B.
        • et al.
        Effect of high amylose resistant starch (HAM-RS2) supplementation on biomarkers of inflammation and oxidative stress in hemodialysis patients: a randomized clinical trial.
        Hemodial Int. 2018; 22: 492-500
        • Esgalhado M.
        • Kemp J.A.
        • Azevedo R.
        • et al.
        Could resistant starch supplementation improve inflammatory and oxidative stress biomarkers and uremic toxins levels in hemodialysis patients? A pilot randomized controlled trial.
        Food Funct. 2018; 9: 6508-6516
        • Cerdó T.
        • García-Santos J.A.
        • M G.B.
        • Campoy C.
        The Role of probiotics and prebiotics in the prevention and treatment of Obesity.
        Nutrients. 2019; 11: 635
        • Loman B.R.
        • Hernández-Saavedra D.
        • An R.
        • Rector R.S.
        Prebiotic and probiotic treatment of nonalcoholic fatty liver disease: a systematic review and meta-analysis.
        Nutr Rev. 2018; 76: 822-839
        • Barichella M.
        • Pacchetti C.
        • Bolliri C.
        • et al.
        Probiotics and prebiotic fiber for constipation associated with Parkinson disease: an RCT.
        Neurology. 2016; 87: 1274-1280
        • Thongprayoon C.
        • Kaewput W.
        • Hatch S.T.
        • et al.
        Effects of probiotics on inflammation and uremic toxins among patients on dialysis: asystematic review and meta-analysis.
        Dig Dis Sci. 2019; 64: 469-479
        • Jia L.
        • Jia Q.
        • Yang J.
        • Jia R.
        • Zhang H.
        Efficacy of probiotics supplementation on chronic kidney disease: a systematic review and meta-analysis.
        KidneyBlood Press Res. 2018; 43: 1623-1635
        • Tao S.
        • Tao S.
        • Cheng Y.
        • et al.
        Effects of probiotic supplements on the progression of chronic kidney disease: a meta-analysis.
        Nephrology (Carlton). 2019; 24: 1122-1130
        • Koppe L.
        • Mafra D.
        • Fouque D.
        Probiotics and chronic kidney disease.
        Kidney Int. 2015; 88: 958-966
        • Sanders M.E.
        • Merenstein D.J.
        • Reid G.
        • Gibson G.R.
        • Rastall R.A.
        Probiotics and prebiotics in intestinal health and disease: from biology to the clinic.
        Nat Rev Gastroenterol Hepatol. 2019; 16: 605-616
        • Mullineaux-Sanders C.
        • Suez J.
        • Elinav E.
        • Frankel G.
        Sieving through gut models of colonization resistance.
        Nat Microbiol. 2018; 3: 132-140
        • Bock P.M.
        • Telo G.H.
        • Ramalho R.
        • et al.
        The effect of probiotics, prebiotics or synbiotics on metabolic outcomes in individuals with diabetes: a systematic review and meta-analysis.
        Diabetologia. 2021; 64: 26-41
        • O'Connor S.
        • Chouinard-Castonguay S.
        • Gagnon C.
        • Rudkowska I.
        Prebiotics in the management of components of the metabolic syndrome.
        Maturitas. 2017; 104: 11-18
        • Hunter P.M.
        • Hegele R.A.
        Functional foods and dietary supplements for the management of dyslipidaemia.
        Nat Rev Endocrinol. 2017; 13: 278-288
        • Firouzi S.
        • Haghighatdoost F.
        The effects of prebiotic, probiotic, and synbiotic supplementation on blood parameters of renal function: a systematic review and meta-analysis of clinical trials.
        Nutrition. 2018; 51-52: 104-113
        • Smith M.I.
        • Yatsunenko T.
        • Manary M.J.
        • et al.
        Gut microbiomes of Malawian twin pairs discordant for kwashiorkor.
        Science. 2013; 339: 548-554
        • Tidjani Alou M.
        • Million M.
        • Traore S.I.
        • et al.
        Gut bacteria Missing in Severe Acute malnutrition, can We Identify potential probiotics by Culturomics?.
        Front Microbiol. 2017; 8: 899
        • Vandeputte D.
        Personalized nutrition through the gut microbiota: current Insights and Future perspectives.
        Nutr Rev. 2020; 78: 66-74
        • Lau W.L.
        • Savoj J.
        • Nakata M.B.
        • Vaziri N.D.
        Altered microbiome in chronic kidney disease: systemic effects of gut-derived uremic toxins.
        Clin Sci (Lond). 2018; 132: 509-522
        • Poesen R.
        • Meijers B.
        • Evenepoel P.
        The colon: an overlooked site for therapeutics in dialysis patients.
        Semin Dial. 2013; 26: 323-332
        • McFarlane C.
        • Ramos C.I.
        • Johnson D.W.
        • Campbell K.L.
        Prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease: asystematic review and meta-analysis.
        J Ren Nutr. 2019; 29: 209-220
        • Guarner F.
        • Khan A.G.
        • Garisch J.
        • et al.
        World Gastroenterology Organisation global Guidelines: probiotics and prebiotics October 2011.
        J Clin Gastroenterol. 2012; 46: 468-481
        • Luo D.
        • Zhao W.
        • Lin Z.
        • et al.
        The effects of hemodialysis and peritoneal dialysis on the gut microbiota of end-stage renal disease patients, and the Relationship between gut microbiota and patient Prognoses.
        Front Cell Infect Microbiol. 2021; 11: 579386
        • Jiang N.
        • Zhang C.
        • Feng H.
        • et al.
        Clinical characteristics associated with the properties of gut microbiota in peritoneal dialysis patients.
        Perit Dial Int. 2021; 41: 298-306