Introduction: Supplementation with probiotics for patients with chronic kidney disease (CKD) may be associated with decreased systemic inflammation. Objective: To assess the impact of oral supplementation with probiotics for patients with CKD on hemodialysis. Method: This double-blind randomized clinical trial included 70 patients on hemodialysis; 32 were given oral supplementation with probiotics and 38 were in the placebo group. Blood samples were collected at the start of the study and patients were given oral supplementation with probiotics or placebo for three months. The probiotic supplement comprised four strains of encapsulated Gram-positive bacteria: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 and Bifidobacterium longum A101. Patients were given one capsule per day for 3 months. Blood samples were taken throughout the study to check for inflammatory biomarkers. Non-traditional biomarkers Syndecan-1, IFN-y, NGAL, and cystatin C were measured using an ELISA kit, along with biochemical parameters CRP, calcium, phosphorus, potassium, PTH, GPT, hematocrit, hemoglobin, glucose, and urea. Results: Patients given supplementation with probiotics had significant decreases in serum levels of syndecan-1 (239 ± 113 to 184 ± 106 ng/mL, p = 0.005); blood glucose levels also decreased significantly (162 ± 112 to 146 ± 74 mg/dL, p = 0.02). Conclusion: Administration of probiotics to patients with advanced CKD was associated with decreases in syndecan-1 and blood glucose levels, indicating potential improvements in metabolism and decreased systemic inflammation.

Chronic kidney disease (CKD) is a growing Public Health problem. Recent evidence points that low education and poor socio-economic conditions are associated with higher risk of developing CKD and progressing to dialysis or transplantation need. Hence patient empowerment through health education and qualification with technological tools that allows better treatment adherence may play an important role in the achievement of optimal clinical outcomes. The Renal Health is a multidisciplinary project created at the University of Fortaleza, northeast Brazil, in 2015, aiming to create novel educational material and technological tools for people with CKD, in different treatment modalities, including dialysis and transplant. The products developed so far in the project include an application for smartphones aiming to help patients in dialysis and transplant in their treatments, including schedule for medications, with alarms, water ingestion control, laboratory tests results, and medical appointments’ agenda, besides all information regarding CKD. The other tools include a medication box, an insole for weight control (both are in the prototype phase), connection with smartbands (for vital signs monitoring) and multimedia educational tools, including a profile in the Instagram and a channel in YouTube. Since the first release of the application in the virtual stores, there were more than 1,000 downloads, predominantly in Brazil, although the app is also available in English and Spanish. All these tools represent innovative ways of patient empowerment and may be increasingly present in daily life. Further studies are required to assess the impact of these tools in patients’ outcomes, including CKD progression and mortality.

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Background and Aims Chronic kidney disease (CKD) have been considered, worldwide, an important public health problem due to its increasing prevalence and its potential consequence in reducing the time and quality of life of affected patients. In addition, the number of individuals with CKD will continue to increase if no strategies are adopted for preventing and delaying the progression of CKD. Thus, corroborating this strategic thinking and the spread of the internet around the world, we developed the Renal Health mobile app (Oliveira et al. Kidney Int Rep. 2019 Jan 28;4(4):609-613). Because it is easily accessible, free of charge and has essential tools for the promotion of renal health, such as diet therapy guidelines, it has conquered users throughout Brazil, connecting patients and health professionals. From this perspective, the objective of this study was to statistically analyze Renal Health application downloads in 16 Brazilian states, where the app was found to be in use. Method Using the Power BI tools and Dashboards it was possible to extract statistical data from the Renal Health application, since its last updated version, last year, to January 2020. Power BI software is a set of analysis and data sharing tools where the main purpose is to generate reports along with Dashboards which is a kind of graphical interface that provides visualizations of key metrics and performance indicators of a mobile application. This way, from this toolkit, it was possible to obtain a real-time and transparent progress report on the number of Renal Health application downloads, with no personal identification of users. Results The 16 Brazilian states under analysis make up a total of 526 Renal Health application downloads by January 2020. Among these states, São Paulo obtained a total of 129 downloads (24.53%), being the place with the largest number of Renal Health users. The second largest state in number of downloads was Ceara, with a total of 111 (21.10%). The states of Rio de Janeiro, Acre and Minas Gerais also obtained a significant number of downloads of the Renal Health application, totaling 53 (10.08%), 48 (9.13%) and 45 (8.56%), respectively (Figure 1). Comparing the results of this study with the last Brazilian Dialysis Survey, which is coordinated by the Brazilian Society of Nephrology, we can observe the coherence of these results, since the states of São Paulo, Minas Gerais and Rio de Janeiro were cited by this survey as the states with the largest prevalence rates of patients undergoing dialysis, evidencing a possible correlation between the use of this type of technological tool (Renal Health) and the highest prevalence of dialytic CKD, once the Renal Health application is a good way to improve patients’ adherence to treatment and help them cope with the disease. Conclusion The Renal Health application is becoming better known by CKD patients in Brazil, and, based on the number of users currently presented in this study, we conclude that there is a growing search for CKD patients for knowledge about kidney disease on mobile platforms. Therefore, there is a challenge to improve new tools with increasingly interactive content and accessible language, as our team intend to do in the next versions of this app.

Resumo Introdução: A suplementação com probióticos na doença renal crônica (DRC) pode estar associada à redução do processo inflamatório sistêmico. Objetivo: Avaliar a suplementação oral com probióticos em pacientes com DRC em hemodiálise. Método: Ensaio clínico, duplo cego, randomizado com 70 pacientes em hemodiálise, sendo 32 do grupo que recebeu o suplemento de probióticos e 38 do grupo placebo. Inicialmente ocorreu a coleta de sangue e suplementação oral com probióticos ou placebo durante três meses. O suplemento probiótico foi composto pela combinação de 4 cepas de bactérias Gram-positivas encapsuladas: Lactobacillus Plantarum A87, Lactobacillus rhamnosus, Bifidobacterium bifidum A218 e Bifidobacterium longum A101, sendo 1 cápsula do suplemento ao dia, durante 3 meses. Após esse período foram feitas novas coletas de sangue para dosagem dos biomarcadores inflamatórios. Foram analisados os biomarcadores não tradicionais: Syndecan-1, IFN-y, NGAL e cistatina C pelo método ELISA, e os seguintes parâmetros bioquímicos: PCR, cálcio, fósforo, potássio, PTH, TGP, hematócrito, hemoglobina, glicose e ureia. Resultados: Os pacientes que receberam suplemento tiveram diminuição significativa dos níveis séricos de syndecan-1 (de 239 ± 113 para 184 ± 106 ng/mL, p = 0,005). Outro parâmetro que diminuiu significativamente nos pacientes que receberam suplemento foi a glicemia (de 162 ± 112 para 146 ± 74 mg/dL, p = 0,02). Conclusão: O uso de probióticos na DRC avançada esteve associado à redução dos níveis de syndecan-1 e glicemia, sinalizando possível melhora no metabolismo e redução do processo inflamatório sistêmico.