An Innovative Synbiotic Formulation Decreases Free Serum Indoxyl Sulfate, Small Intestine Permeability and Ameliorates Gastrointestinal Symptoms in a Randomized Pilot Trial in Stage IIIb-IV CKD Patients

Cosola, Carmela; Rocchetti, Maria Teresa; Bari, Ighli di; Acquaviva, Paola Maria; Maranzano, Valentina; Corciulo, Simone; Ciaula, Agostino Di; Palo, Domenica Maria Di; Forgia, Flavia Maria la; Fontana, Simona; Angelis, Maria De; Portincasa, Piero; Gesualdo, Loreto

doi:10.3390/toxins13050334

Cited by 42 publications

(35 citation statements)

References 43 publications

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“…The glomerular filtration rate was improved significantly in patients who were on the low-protein diet combined with prebiotics and probiotics [ 35 ]. Similar results were drawn from the other two clinical controlled trials on the probiotic intakes that were associated with a decline in the progression of CKD [ 13 , 36 ].…”

Section: Effect Of Probiotics In Advanced Stage Of Ckd (Stage 3–5nd)supporting

confidence: 83%

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The Potential Benefits and Controversies of Probiotics Use in Patients at Different Stages of Chronic Kidney Disease

Tian

et al. 2022

Nutrients

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The therapeutic modulation of the gut microbiome has been suggested to be one of the tools in the integrated management of chronic kidney disease (CKD) in recent years. Lactobacillus and Bifidobacterium genera are the two most commonly used probiotics strains. Most of the probiotics used in studies are mixed formulation. There is no consensus on the dose and duration of the probiotic administration for CKD patients Increasing evidence indicates that patients with early stage (1–2) CKD have an altered quantitative and qualitative microbiota profile. However, there was a dearth of prospective controlled studies on the use of probiotics in the early stage of the CKD population. The association between gut microbiota disturbance and advanced CKD was reported. Most randomized controlled trials on probiotic treatment used in CKD stage 3–5ND patients reported positive results. The metabolites of abnormal gut microbiota are directly involved in the pathogenetic mechanisms of cardiovascular disease and inflammation. We summarized 13 studies performed in the dialysis population, including 10 in hemodialysis (HD) patients and 3 in peritoneal dialysis (PD). Some controversial results were concluded on the decreasing plasma concentration of uremic toxin, symptoms, inflammation, and cardiovascular risk. Only three randomized controlled trials on PD were reported to show the potential beneficial effects of probiotics on inflammation, uremic toxins and gastrointestinal symptoms. There is still no standard in the dosage and duration of the use of probiotics in CKD patients. Overall, the probiotic administration may have potential benefit in improving symptoms and quality of life, reducing inflammation, and delaying the progression of kidney failure. Further research studies using a larger sample size with longer follow-up durations and a greater focus on clinical outcomes—including survival—are warranted to elucidate the significant clinical impact of the use of probiotics in CKD patients.

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Section: Effect Of Probiotics In Advanced Stage Of Ckd (Stage 3–5nd)supporting

confidence: 83%

“…Most of the probiotics used in the studies were mixed formulation, accounting for 80% of the total. Multiple probiotic products are now marketed and the efficacy, safety, and tolerance were shown in some trials [ 11 , 12 , 13 ].…”

Section: Overview Of Probiotics Used In Ckdmentioning

confidence: 99%

The Potential Benefits and Controversies of Probiotics Use in Patients at Different Stages of Chronic Kidney Disease

Tian

et al. 2022

Nutrients

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“…Four studies [ 15 , 18 , 20 , 23 ] were involved in the assessment of effects of probiotics on serum creatinine in non-dialysis patients and no statistically significant difference was found [SMD = −0.26; 95%CI: (−0.96, 0.44); p = 0.46] with a high heterogeneity (I 2 = 82%) ( Figure 3(A) ). Both prebiotics subgroup [ 21 , 22 , 25 ], [SMD = 0.22; 95%CI: (−0.13, 0.57); p = 0.21; I 2 = 6%] and synbiotics subgroup [ 16 , 17 , 19 , 24 , 26 ], [SMD = 0.15; 95%CI: (−0.16, 0.46); p = 0.34; I 2 = 40%] did not show a significant decrease in serum creatinine level ( Figure 3(B,C) ). The heterogeneity of the SMDs was considered low in prebiotics subgroup and synbiotics subgroup.…”

Section: Resultsmentioning

confidence: 99%

“…The heterogeneity of the SMDs was considered high. Eight RCTs [ 15 , 17 , 19 , 20 , 22 , 24–26 ] with biotic intervention longer than 2 months also showed no significant difference in their meta-analysis [SMD = 0.17; 95%CI: (−0.03, 0.38); p = 0.10; I 2 = 17%] ( Figure 4(B) ). Heterogeneity was removed with a duration more than 2 months.…”

Section: Resultsmentioning

confidence: 99%

Effects of prebiotics, probiotics and synbiotics on serum creatinine in non-dialysis patients: a meta-analysis of randomized controlled trials

Liu

et al. 2023

Renal Failure

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Objective Serum creatinine level are influenced by many factors. Although accumulated data suggested that prebiotics, probiotics and synbiotics supplements could affect serum creatinine level, the results remained controversial. The aim of the present paper was to evaluate the effects of prebiotics, probiotics and synbiotics on serum creatinine in non-dialysis patients. Methods PubMed, EMBASE (Excerpta Medica Database) and the Cochrane Library databases were searched for eligible randomized, controlled trials (RCTs) which were limited to English language studies until 30 September 2022. A random-effects model was performed to analyze the impact of pooled trials. Result Twelve randomized, controlled trial studies were included in the meta-analysis. Prebiotics, probiotics or synbiotics supplementation did not significantly decrease the serum creatinine levels in non-dialysis patients compared to placebo [standardized mean difference (SMD) = 0.05; 95% confidence interval (CI): (−0.21, 0.31); p = 0.72; I 2 = 61%]. Conclusion The present meta-analysis indicated that supplementation with prebiotics, probiotics and synbiotics could not act as promising adjuvant therapies to decrease the serum creatinine levels in non-dialysis patients.

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“…In the synbiotic group, a reduction in zonulin level was observed, together with the increased variety of the gut bacteria. A recent study showed that NATUREN G ® synbiotic can reduce intestinal permeability in patients with chronic kidney disease [ 165 ]. Two-month intake of synbiotics resulted in positive changes in the intestine, including a reduction of abdominal pain, constipation syndrome and small intestinal permeability.…”

Section: Synbioticsmentioning

confidence: 99%

Overview of the Importance of Biotics in Gut Barrier Integrity

Kocot

Jarocka-Cyrta

Drabińska

2022

IJMS

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Increased gut permeability is suggested to be involved in the pathogenesis of a growing number of disorders. The altered intestinal barrier and the subsequent translocation of bacteria or bacterial products into the internal milieu of the human body induce the inflammatory state. Gut microbiota maintains intestinal epithelium integrity. Since dysbiosis contributes to increased gut permeability, the interventions that change the gut microbiota and correct dysbiosis are suggested to also restore intestinal barrier function. In this review, the current knowledge on the role of biotics (probiotics, prebiotics, synbiotics and postbiotics) in maintaining the intestinal barrier function is summarized. The potential outcome of the results from in vitro and animal studies is presented, and the need for further well-designed randomized clinical trials is highlighted. Moreover, we indicate the need to understand the mechanisms by which biotics regulate the function of the intestinal barrier. This review is concluded with the future direction and requirement of studies involving biotics and gut barrier.

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An Innovative Synbiotic Formulation Decreases Free Serum Indoxyl Sulfate, Small Intestine Permeability and Ameliorates Gastrointestinal Symptoms in a Randomized Pilot Trial in Stage IIIb-IV CKD Patients

Cited by 42 publications

References 43 publications

The Potential Benefits and Controversies of Probiotics Use in Patients at Different Stages of Chronic Kidney Disease

The Potential Benefits and Controversies of Probiotics Use in Patients at Different Stages of Chronic Kidney Disease

Effects of prebiotics, probiotics and synbiotics on serum creatinine in non-dialysis patients: a meta-analysis of randomized controlled trials

Overview of the Importance of Biotics in Gut Barrier Integrity

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