Probiotics and CKD Progression: Are Creatinine-Based Estimates of GFR Applicable? (original) (raw)
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European journal of nutrition, 2018
Gut dysbiosis has been described in advanced, but not in initial stages of CKD. Considering the relevant impact of gut dysbiosis on renal and cardiovascular risk, its diagnosis and treatment are clinically relevant. We designed, open-label, placebo-controlled intervention study (ProbiotiCKD) to evaluate gut microbiota metabolism in a cohort of KDIGO CKD patients (n = 28) at baseline and after a randomly assigned treatment with probiotics or placebo. Gut microbiota status was evaluated on:. Basal mean fecal Lactobacillales and Bifidobacteria concentrations were abnormally low in both groups, while urinary indican and 3-MI levels were, indicating a mixed (fermentative and putrefactive) dysbiosis. After treatment, mean fecal Lactobacillales and Bifidobacteria concentrations were increased, only in the probiotics group (p < 0.001). Conversely, mean urinary indican and 3-MI levels only in the group treated with probiotics (p < 0.001). Compared to placebo group, significant improvem...
Effect of probiotics on human blood urea levels in patients with chronic renal failure
Introduction: Patients with chronic kidney disease (CKD) show an increase in bowel aerobic bacteria that produce uremic toxins and decreased anaerobic bacteria as bifidobacteria and lactobacillus. The latter can be used as probiotics. The probiotic with greater availability in Mexico, is the lactobacillus casei shirota (LcS), currently there is no known LcS specified dose that produces a benefit to the patient with CKD. Objective: To determine the effectiveness of two different LcS doses in achieving a decrease in urea concentrations of at least 10% in patients with KDOQI stage 3 and stage 4 CKD. Metodology: A simple randomized, controlled clinical trial. Outpatients treated at the National Institute of Medical Sciences and Nutrition Salvador Zubirán in México D.F. Patients were provided the LcS, as follows: Group A: 8 x 10 9 colony-forming units (CFU) and Group B: 16 x 10 9 CFU. Patients were followed-up for eight weeks, and baseline and final samples were obtained to calculate the basal and final concentrations, respectively, of blood urea and serum creatinine (CrS). During the follow-up, both groups consumed a diet of 30 kcal/kg/weight and 0.8 g/kg/weight of protein, and a food diary was made to assess both the adherence to the diet and LcS. Results: Thirty patients with CKD were evaluated. When analyzing the percentage change between the different doses, a decrease > 10% was found in the blood urea concentrations for patients treated with the 16 x 10 9 dose, which was significant with respect to the baseline measurement. Conclusion: There was a > 10% decrease in the serum urea concentrations with LcS in patients with stage 3 and 4 CRF.
Introduction: Uremic syndrome consists of nitrogenous waste retention, deficiency in kidney-derived hormones, and reduced acid excretion, and, if untreated, may progress to coma and eventual death. Previous experience suggests that oral administration of a probiotic formulation of selected microbial strains may 0059-9 9 634 extend renoprotection via intraintestinal extraction of toxic waste solutes in patients with chronic kidney disease (CKD) stages 3 and 4. This report presents preliminary data from a pilot study. Methods: This was a 6-month prospective, randomized, double-blind, placebocontrolled crossover trial of a probiotic bacterial formulation conducted in four countries, at five institutions, on 46 outpatients with CKD stages 3 and 4: USA (n=10), Canada (n=13), Nigeria (n=15), and Argentina (n=8). Outcomes were compared using biochemical parameters: blood urea nitrogen (BUN), serum creatinine, and uric acid. General well-being was assessed as a secondary parameter by a quality of life (QOL) questionnaire on a subjective scale of 1-10. Results: Oral ingestion of probiotics (90 billion colony forming units [CFUs]/day) was well tolerated and safe during the entire trial period at all sites. BUN levels decreased in 29 patients (63%, P<0.05), creatinine levels decreased in 20 patients (43%, no statistical significance), and uric acid levels decreased in 15 patients (33%, no statistical significance). Almost all subjects expressed a perceived substantial overall improvement in QOL (86%, P<0.05). Conclusion: The main outcomes of this preliminary trial include a significant reduction Adv Ther (2010) 27(9):634-647. 635 of BUN, enhanced well-being, and absence of serious adverse effects, thus supporting the use of the chosen probiotic formulation for bowel-based toxic solute extraction. QOL and BUN levels showed statistically significant differences in outcome (P<0.05) between placebo and probiotic treatment periods at all four sites (46 patients). A major limitation of this trial is the small sample size and related inconsistencies.
Journal of Renal Nutrition
Objective: The objective of the study was to evaluate the effects of probiotic supplementation on the gut microbiota profile and inflammatory markers in chronic kidney disease patients undergoing maintenance hemodialysis (HD). Design and Methods: This was a randomized, double-blind, placebo-controlled study. Forty-six HD patients were assigned to receive 1 of 2 treatments: probiotic (n 5 23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacterialongum, 90 billion colony-forming units per day) or placebo (n 5 23) daily for 3 months. Blood and feces were collected at baseline and after intervention. The inflammatory markers (C-reactive protein and interleukin-6) were analyzed by immunoenzymatic assay (enzyme-linked immunosorbent assay). Uremic toxins plasma levels (indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid) were obtained by Reversed-Phase High-Performance Liquid Chromatography. Routine laboratory parameters were measured by standard techniques. Fecal pH was measured by the colorimetric method, and the gut microbiota profile was assessed by Denaturing Gradient Gel Electrophoresis analysis. Results: Sixteen patients remained in the probiotic group (11 men, 53.6 6 11.0 year old, 25.3 6 4.6 kg/m 2) and 17 in the placebo group (10 men, 50.3 6 8.5 year old, 25.2 6 5.7 kg/m 2). After probiotic supplementation there was a significant increase in serum urea (from 149.6 6 34.2 mg/dL to 172.6 6 45.0 mg/dL, P 5 .02), potassium (from 4.4 6 0.4 mmol/L to 4.8 6 0.4 mmol/L, P 5 .02), and indoxyl sulfate (from 31.2 6 15.9 to 36.5 6 15.0 mg/dL, P 5 .02). The fecal pH was reduced from 7.2 6 0.8 to 6.5 6 0.5 (P 5 .01). These parameters did not change significantly in placebo group. Changes in the percentage delta (D) between groups were exhibited with no statistical differences observed. The inflammatory markers and gut profile were not altered by supplementation. Conclusions: Aprobiotic supplementation failed to reduce uremic toxins and inflammatory markers. Therefore, probiotic therapy should be chosen with caution in HD patients. Further studies addressing probiotic therapy in chronic kidney disease patients are needed.
International Journal of Nephrology and Kidney Failure
Background: Based on the concept of "Enteric Dialysis®" Kibow Biotech's proprietary patented kidney health supplement, has proven helpful in many suffering from CKD, for healthy kidney function by gut microbiome modulation. Available since 2010, it is continually being studied to assess its effectiveness. This survey was to evaluate GFR changes as measured in mL/min per 1.73 m 2 , and quality of life (QoL) improvements in customers taking this synbiotic dietary supplement along with their standard care of therapy. Methods: A survey was distributed to 600 customers taking this product. Questions included GFR before taking this supplement, and at their most recent doctor's visit, age, race, ethnicity, and QoL. GFR data and QoL was analyzed statistically. 214 (35%) survey responses were received. Results: The average survey participant was 69 years and using this proprietary supplement for 2.05 years. 150 surveys contained complete information, including GFR. Baseline GFR was 4 to 100 with an average of 29. The most recent GFR varied from 5 to 102. The highest impact on GFR was an increase of 65, and the largest decrease in GFR was-43. The average change in GFR for a survey participant was an increase of 3.55 mL/min/1.73 m ². 88% of survey participants reported this product improved their QoL. Conclusion: CKD is generally recognized as a degenerative process. With over 4,000 customers using this pro/prebiotic patented dietary supplement we sought feedback from 15% to assess its impact over an average use of 2.05 years. The longest usage of the product was 7 years, the shortest-6 months. With the ability to stabilize and improve GFR, it may be possible to delay all stages of kidney failure progression. Improved QoL in 88% of participants certainly signifies the advantages of using this patented supplement in patients with compromised renal function worldwide.
Probiotics in the treatment of chronic kidney disease: a systematic review
Brazilian Journal of Nephrology, 2018
Chronic kidney disease (CKD) is a syndrome caused by the progressive reduction of renal function. This study aimed to systematically examine the effects of supplementation with probiotics in the treatment of CKD. Searches were carried out on databases MEDLINE (PubMed), SciELO, Cochrane, and Clinical Trials. Two independent reviewers selected the studies from which data was extracted. The search included papers written in English and Portuguese published in the 2012-2016 period describing randomized clinical trials. Eight of the 82 eligible articles met the inclusion criteria. Sample size ranged from 18 to 101 individuals with CKD. The duration of the included studies varied from four to 24 weeks. Most of the included articles reported positive effects in renal function and decreased levels of urea, blood urea nitrogen, ammonia, plasma p-cresol, p-cresyl sulfate, and indoxyl sulfate.
Specific Probiotics for Chronic Kidney Disease : A Review
2019
Chronic kidney disease (CKD) is a global health issue with a high economic cost to health systems and one of the risk factor for cardiovascular disease (CVD). All stages of CKD are associated with decreased quality of life. CKD is usually asymptomatic until later stages. Probiotics are living micro-organism very well known for a role they in the prevention and reduction of risk factors for several diseases and are also capable of enhancing certain vital physiological functions. A normal human digestive tract contains about 400 types (strains) of probiotic bacteria that control and reduce the growth of harmful bacteria and promote a healthy digestive system. The application of probiotics to kidney health is an emerging area of medicine that has only recently come into attention of scientists. In CKD patients there is a build-up of poisonous wastes in the bloodstream due to the overloaded and impaired kidneys. Certain probiotic microorganisms can utilize urea, uric acid, creatinine an...
Nutrients
The probiotics-supplemented low-protein diet in chronic kidney disease (ProLowCKD) was a single-centre, double-blind, placebo-controlled, randomised trial that was conducted to investigate whether the association between a low protein diet (LPD) and a new formulation of probiotics (Bifidobacterium longum and Lactobacillus reuteri) was effective at reducing traditional uremic, microbiota-derived, and proatherogenic toxins in sixty patients affected by advanced CKD. After 2 months of a LPD—a reduction in blood urea nitrogen (52 ± 17 vs. 46 ± 15 mg/dL, p = 0.003), total cholesterol (185 ± 41 vs. 171 ± 34 mg/dL, p = 0.001), and triglycerides (194 ± 148 vs. 161 ± 70 mg/dL, p = 0.03) was observed; 57 subjects were then randomized to receive probiotics or a placebo for the subsequent 3 months. A total of 27 patients in the placebo group showed increased serum values of total cholesterol (169 ± 36 vs. 185 ± 40 mg/dL, p = 0.01), LDL cholesterol (169 ± 36 vs. 185 ± 40 mg/dL, p = 0.02), lipopr...
Microbiota issue in CKD: how promising are gut-targeted approaches?
Journal of Nephrology, 2018
In chronic kidney disease (CKD), the progressive decline in the renal excretory function leads to accumulation of urea and toxins in the blood. The CKD-associated dysbiosis of gut microbiota further contributes to uremia by increasing intestinal toxins production. Gut microbiota is involved in a complex network of human organs, mediated by microbial metabolites: in CKD, gut-heart and gut-brain axes may have a role in increased cardiovascular risk and neuropsychiatric disorders. While the cardiovascular toxicity of some microbial molecules is well known, their presumptive neurotoxicity needs to be confirmed by specific studies. In this review, we describe gut-heart and gut-brain axes in CKD, with an overview of the experimental and human studies characterizing CKD-associated gut microbiota, and we discuss the benefits coming from new approaches aimed at gut manipulation. Microbiota metabolism is emerging as a modifiable non-traditional risk factor in nephrology. In order to take advantage of this issue, it is necessary to consider the microbiota manipulation as part of the nutritional management of CKD. Integrating the low-protein nutritional approach with prebiotic, probiotic and synbiotic supplementation is a promising tool to control disease progression and comorbidities, though an extensive validation in large-scale clinical trials is still required.