Are probiotics beneficial to patients with chronic kidney disease on hemodialysis?

Chronic kidney disease is shown to be associated with a pro-inflammatory state, and the eating habits of CKD patients may be linked to such conditions. CKD patients on hemodialysis may be more susceptible to gut dysbiosis, which increases complications risk in patients with CKD and cardiovascular disease. Probiotics use may enhance immune response, restore intestinal permeability, enrich the gut microbiota, and boost anti-inflammatory effects through dysbiosis correcting, thus potentially producing beneficial outcomes for CKD patients.

Recent studies on probiotics administration to CKD patients have shown favorable effects seen as a reduction in the levels of biomarkers of inflammation (interleukin-6), oxidative stress (malondialdehyde), ammonia, urea, and p-cresol, among other positive effects.

Against the above background, the research team from Brazil led by Érica Maria Rodrigues de Araújo aimed to determine the impact of oral supplementation with probiotics for CKD patients on hemodialysis in a double-blind, randomized clinical trial.

The trial included 70 patients on hemodialysis, of which 32 were given oral supplementation with probiotics and 38 were placed in the placebo group. Ten participants left the trial. Eight patients in the Group given supplementation with probiotics left the study. In the Group given a placebo, one patient was hospitalized, and one changed clinics during the trial.

Blood samples were collected at the study's initiation, and patients were given oral supplementation with probiotics or a placebo for three months. The probiotic supplement consisted of four strains of encapsulated Gram-positive bacteria: Lactobacillus rhamnosus, Lactobacillus Plantarum A87, Bifidobacterium longum A101, and Bifidobacterium bifidum A218.

Patients were provided one capsule per day for three months. Throughout the study, blood samples were taken to check for inflammatory biomarkers. Non-traditional biomarkers IFN-y, Syndecan-1, cystatin C, and NGAL were measured using an ELISA kit, along with biochemical parameters calcium, CRP, potassium, phosphorus, GPT, PTH, hemoglobin, hematocrit, urea, and glucose.

The trial yielded the following findings:

· The researchers found similar baseline characteristics of the patients in the two groups. Levels of PTH were the only significant difference found, with patients in the Group given supplementation presenting higher levels.

· The authors found no significant difference in comparing the individuals' given probiotics and the patients offered a placebo at the end of the supplementation period.

· Matched analysis of all parameters between the two time periods (before vs. after supplementation) and groups (placebo vs. probiotics) found a significant association after three months between inflammatory mediators and the use of probiotics.

• In the placebo group, the levels of inflammatory mediator CRP decreased at the end of the trial (1563 ± 783 to 860 ± 331 ng/mL). Other parameters did not differ statistically in this Group when levels before and after treatment were compared.
• In the Group given probiotics, CRP levels also decreased significantly (1626 ± 617 to 898 ± 313 ng/mL) when serum levels before and after supplementation were compared.
• Hemoglobin and hematocrit levels increased significantly in the Group given probiotics. In the Group given probiotics, no significant decrease was observed in kidney parameters, including serum NGAL and cystatin C.
• Blood levels of syndecan-1, a marker of endothelial glycocalyx, decreased significantly in patients given probiotics (239 ± 113 to 184 ± 106 ng/mL). Blood glucose was also considerably reduced in probiotic patients (162 ± 112 to 146 ± 74 mg/dL).

Shedding light on the study's limitations, the researchers wrote, "since these findings were derived from a small patient population, more advanced statistical analyses were not performed, nor was it feasible to analyze the effect of potential confounding factors."

"There is a need for studies with a longer follow-up period including patients with other CKD stages for better understanding the effects of probiotics on patients with kidney disease," they conclude.

Reference:

de Araújo, Érica Maria Rodrigues, et al. "Use of Probiotics in Patients With Chronic Kidney Disease On Hemodialysis: a Randomized Clinical Trial." Jornal Brasileiro De Nefrologia : 'orgao Oficial De Sociedades Brasileira E Latino-Americana De Nefrologia, 2022.