Effects of Probiotics, Prebiotics, and Synbiotics on Uremic Toxins, Inflammation, and Oxidative Stress in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

The dysbiosis of gut microbiota may cause many complications in patients with end-stage renal disease, which may be alleviated by probiotic, prebiotic, and synbiotic supplementation. The aim of this systematic review and meta-analysis was to assess the effects of these supplementations on circulatory uremic toxins, biomarkers of inflammation, and oxidative stress in hemodialysis patients. We searched the EMBASE, MEDLINE, Web of Science, and Cochrane Library databases until 8 August 2021. Randomized controlled trials evaluating adult patients receiving hemodialysis were included. The pooled results from 23 studies with 931 hemodialysis patients indicated that interventions significantly decreased the circulating levels of p-cresyl sulfate (standardized mean difference (SMD): 0.38; 95% CI: −0.61, −0.15; p = 0.001), endotoxins (SMD: −0.58; 95% CI: −0.99, −0.18; p = 0.005), malondialdehyde (SMD: −1.16; 95% CI: −1.81, −0.52; p = 0.0004), C-reactive proteins (CRP) (SMD: −0.61; 95% CI: −0.99, −0.23; p = 0.002), and interleukin 6 (SMD: −0.92; 95% CI: −1.51, −0.33; p = 0.002), and improved the total antioxidant capacity (SMD: 0.89; 95% CI: 0.49, 1.30; p < 0.0001) and glutathione (SMD: 0.40; 95% CI: 0.14, 0.66; p = 0.003) when compared to the placebo group. Our results suggest that treatment with probiotics, prebiotics, and synbiotics may help alleviate uremic toxin levels, oxidative stress, and the inflammatory status in hemodialysis patients.

Effect of Green Tea Supplementation on Antioxidant Status in Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

“…Increased oxidative stress elevates the risk of chronic diseases, such as cardiovascular and end-stage renal disease, as it is related to the onset and progression of these adverse conditions [ 11 , 12 , 62 , 63 ]. A greater antioxidant intake has been previously related to a lower risk of disease mortality [ 62 ].…”

“…All metabolic processes generate reactive oxygen species (ROS), which can induce oxidative damage to tissue and cell constituents such as lipids, proteins, and nucleic acids [ 1 , 2 ] when left unbalanced. Indeed, the overproduction and accumulation of large amounts of ROS lead to oxidative stress [ 3 , 4 , 5 ], which represents a major contributor to the risk, onset, and progression of chronic diseases [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. A key component of oxidative stress implicated in adverse health effects is lipid peroxidation of polyunsaturated fatty acids and the subsequent production of malondialdehyde (MDA) (a major indicator of lipid oxidation) [ 9 ].…”

Fabry disease – a multisystemic disease with gastrointestinal manifestations

“…A dysbiosis in FD patients with renal impairment might further be triggered by an increased urea secretion into the digestive system, contributing to circulating uremic toxins, systemic inflammation, oxidative stress, cardiovascular events, and other complications as observed in patients with end-stage renal disease (ESRD). 53 …”

Probiotics, Prebiotics, and Synbiotics Improve Uremic, Inflammatory, and Gastrointestinal Symptoms in End-Stage Renal Disease With Dialysis: A Network Meta-Analysis of Randomized Controlled Trials

“…MDA is a low-molecular-weight solution that participates in oxidative stress, connecting with the progress of CKD and its cardiovascular complications ( 51 ). Seven randomized controlled trials were introduced in the study of Nguyen et al ( 14 ), who found that MDA was significantly reduced in hemodialysis patients after taking three supplements. Several studies also have demonstrated that synbiotics might increase the expression of the antioxidant gene SOD and GPX in the gut by targeting gut bacteria to activate oxidative stability ( 52 , 53 ).…”

“…However, their efficacy in reducing various indexes has not yet been determined. For example, a meta-analysis from March et al ( 13 ) evaluated the effects of pro/pre/syn-biotics and found a significant reduction in indoxyl sulfate (IS), whereas another meta-analysis ( 14 ) reported these supplements have potential benefits to decrease p-Cresyl sulfate (PCS) instead IS in hemodialysis patients. To our knowledge, the available evidence may not provide a consistent conclusion among the three supplements.…”