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Consumers’ Perspectives and Experiences of Prebiotics and Probiotics for Gut Health in Chronic Kidney Disease

Published:April 22, 2022DOI:https://doi.org/10.1053/j.jrn.2022.04.003

      Objectives

      Nutrition supplementation, including prebiotics and probiotics, is a therapeutic strategy for modulating the gut microbiome in chronic kidney disease (CKD). However, the acceptability of gut-targeted supplements in this population remains largely unexplored. This study aims to describe the perceptions of nutrition supplementation, and the acceptability and experiences of pre- and probiotics in adults with Stage 3-4 CKD.

      Design and Methods

      Semi-structured interview study of adults with Stage 3-4 CKD (n = 30), aged 41-80 (mean 68) years, who completed a 12-month prebiotic and probiotic intervention or placebo, were interviewed between January and March 2019. Interviews were transcribed verbatim and analyzed thematically.

      Results

      Five themes were identified: integrating and sustaining routine supplementation (flexibility in prescription of prebiotics and probiotics, fitting in with regular routines); striving for health benefits (hoping to improve kidney health, hoping to improve general health, confirming health benefits); facilitating pre- and probiotic supplementation (perceiving pre- and probiotics as safe, side-effects from taking pre- and probiotics); empowering knowledge (valuing the opportunity to increase knowledge of gut health); and considerations for future use (questioning credibility of health claims, average palatability of prebiotic powder, cost concerns).

      Conclusions

      Adults with Stage 3-4 CKD found pre- and probiotic supplements to be acceptable and complementary gut-targeted supplements. Individual preferences for nutrition supplementation should be considered alongside health knowledge to enhance uptake and adherence in practice.

      Key Words

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      References

        • Australian New Zealand Clinical Trials Registry
        Synbiotics Easing renal failure by improving gut microbiology II (SYNERGY II): a randomized controlled trial.
        2017
        • Hill N.R.
        • Fatoba S.T.
        • Oke J.L.
        • et al.
        Global Prevalence of chronic kidney disease - a Systematic review and Meta-analysis.
        PLoS One. 2016; 11: e0158765
        • Bello A.K.
        • Levin A.
        • Tonelli M.
        • et al.
        Assessment of Global kidney health care Status.
        JAMA. 2017; 317: 1864-1881
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • McCulloch C.E.
        • Hsu C.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Moradi H.
        • Sica D.A.
        • Kalantar-Zadeh K.
        Cardiovascular burden associated with uremic toxins in patients with chronic kidney disease.
        Am J Nephrol. 2013; 38: 136-148
        • Stenvinkel P.
        • Carrero J.J.
        • Axelsson J.
        • Lindholm B.
        • Heimbürger O.
        • Massy Z.
        Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle?.
        Clin J Am Soc Nephrol. 2008; 3: 505-521
        • Liabeuf S.
        • Barreto D.V.
        • Barreto F.C.
        • et al.
        Free p-cresyl sulphate is a predictor of mortality in patients at different stages of chronic kidney disease.
        Nephrol Dial Transplant. 2010; 25: 1183-1191
        • Lin C.J.
        • Liu H.L.
        • Pan C.F.
        • et al.
        Indoxyl sulfate predicts cardiovascular disease and renal function deterioration in advanced chronic kidney disease.
        Arch Med Res. 2012; 43: 451-456
        • Snelson M.
        • Biruete A.
        • McFarlane C.
        • Campbell K.
        A renal Clinician's guide to the gut microbiota.
        J Ren Nutr. 2020; 30: 384-395
        • McFarlane C.
        • Ramos C.I.
        • Johnson D.W.
        • Campbell K.L.
        Prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease: a Systematic review and Meta-analysis.
        J Ren Nutr. 2019; 29: 209-220
        • Kelly J.T.
        • Campbell K.L.
        • Hoffmann T.
        • Reidlinger D.P.
        Patient experiences of dietary Management in chronic kidney disease: a Focus group study.
        J Ren Nutr. 2018; 28: 393-402
        • Chow J.
        Probiotics and prebiotics: a brief overview.
        J Ren Nutr. 2002; 12: 76-86
        • Siro I.
        • Kapolna E.
        • Kapolna B.
        • Lugasi A.
        Functional food. Product development, marketing and consumer acceptance--a review.
        Appetite. 2008; 51: 456-467
        • Canganella F.
        • Paganini S.
        • Ovidi M.
        • et al.
        A microbiological investigation on probiotic pharmaceutical products used for human health.
        Microbiol Res. 1997; 152: 171-179
        • Jo Delaney L.
        Patient-centred care as an approach to improving health care in Australia.
        Collegian. 2018; 25: 119-123
        • Malterud K.
        • Siersma V.D.
        • Guassora A.D.
        Sample size in qualitative interview studies: guided by information power.
        Qual Health Res. 2016; 26: 1753-1760
        • Sekhon M.
        • Cartwright M.
        • Francis J.J.
        Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework.
        BMC Health Serv Res. 2017; 17: 88
        • Marx W.
        • Kiss N.
        • McKavanagh D.
        • Isenring E.
        Attitudes, beliefs and behaviours of Australia dietitians regarding dietary supplements: a cross-sectional survey.
        Complement Ther Clin Pract. 2016; 25: 87-91
        • Armstrong A.R.
        • Thiebaut S.P.
        • Brown L.J.
        • Nepal B.
        Australian adults use complementary and alternative medicine in the treatment of chronic illness: a national study.
        Aust N Z J Public Health. 2011; 35: 384-390
      1. QSR International Pty Ltd.
        (NVivo (Version 12).)
        • Glaser B.G.
        • Strauss A.L.
        The Discovery of Grounded Theory: Strategies for Qualitative Research.
        1st ed. Routledge, New York, NY1999
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Therapeutic Goods Administration
        Overview of the regulation of listed medicines and registered complementary medicines.
        (Version 1.1.)
        • Rossi M.
        • Johnson D.W.
        • Morrison M.
        • et al.
        Synbiotics easing renal failure by improving gut microbiology (SYNERGY): a randomized trial.
        Clin J Am Soc Nephrol. 2016; 11: 223-231
        • Cruz-Mora J.
        • Martinez-Hernandez N.E.
        • Martin del Campo-Lopez F.
        • et al.
        Effects of a symbiotic on gut microbiota in Mexican patients with end-stage renal disease.
        J Ren Nutr. 2014; 24: 330-335
        • McFarlane C.
        • Krishnasamy R.
        • Stanton T.
        • et al.
        MO590GUT health interventions IN chronic kidney disease: acceptability and FEASIBILITY OF OF synbiotic supplementation.
        Nephrol Dial Transplant. 2021; 36 (gfab089.003)
        • Guida B.
        • Germano R.
        • Trio R.
        • et al.
        Effect of short-term synbiotic treatment on plasma p-cresol levels in patients with chronic renal failure: a randomized clinical trial.
        Nutr Metab Cardiovasc Dis. 2014; 24: 1043-1049
        • Cedillo-Couvert E.A.
        • Ricardo A.C.
        • Chen J.
        • et al.
        Self-reported medication adherence and CKD progression.
        Kidney Int Rep. 2018; 3: 645-651
        • McFarlane CK R.
        • Stanton T.
        • Savill E.
        • et al.
        Synbiotics easing renal failure by improving gut microbiology II (SYNERGY II): a Feasibility randomized controlled trial.
        Nutrients. 2021; 13: 4481
        • Flanagan K.
        Preoperative assessment: safety considerations for patients taking herbal products.
        J Perianesth Nurs. 2001; 16: 19-26
        • Eisenberg D.M.
        • Davis R.B.
        • Ettner S.L.
        • et al.
        Trends in alternative medicine Use in the United States, 1990-1997.
        JAMA. 1998; 280: 1569-1575
        • Kelly J.T.
        • Conley M.
        • Hoffmann T.
        • et al.
        A Coaching program to improve dietary intake of patients with CKD: ENTICE-CKD.
        Clin J Am Soc Nephrol. 2020; 15: 330-340
        • Raben A.
        • Tagliabue A.
        • Christensen N.J.
        • Madsen J.
        • Holst J.J.
        • Astrup A.
        Resistant starch: the effect on postprandial glycemia, hormonal response, and satiety.
        Am J Clin Nutr. 1994; 60: 544-551
        • Scott K.P.
        • Grimaldi R.
        • Cunningham M.
        • et al.
        Developments in understanding and applying prebiotics in research and practice—an ISAPP conference paper.
        J Appl Microbiol. 2020; 128: 934-949
        • Mafra D.
        • Borges N.
        • Alvarenga L.
        • et al.
        Dietary components that may influence the Disturbed gut microbiota in chronic kidney disease.
        Nutrients. 2019; 11: 496