Inhibition of the Accumulation of Uremic Toxins in the Blood and Their Precursors in the Feces after Oral Administration of Lebenin®, a Lactic Acid Bacteria Preparation, to Uremic Patients Undergoing Hemodialysis

Abstract

The plasma levels of phenol, p-cresol, and indican are markedly increased in uremic patients, and cannot be efficiently reduced by hemodialysis. Such uremic toxins, which are produced in the intestine as bacterial putrefactive metabolites, accumulate to a great degree in the feces of hemodialysis patients. Oral administration of Lebenin®, a preparation consisting of antibiotic-resistant lactic acid bacteria, reduced the levels of fecal putrefactive metabolites to levels comparable with those of healthy subjects. Moreover, the plasma level of indican also significantly decreased in these Lebenin-treated patients. An analysis of the fecal microflora revealed that a disturbed composition of the microflora characterized by an overgrowth of aerobic bacteria is restored to normal by oral administration of Lebenin in hemodialysis patients. These results thus demonstate that oral administration of lactic acid bacteria in uremic patients is effective in reducing the levels of uremic toxins, especially that of indican, in the blood by inhibiting bacterial production by means of correcting the intestinal microflora.

Micronutrient Metabolism in Hemodialysis Patients

“…The same authors also demonstrated that oligo-fructose-inulin significantly reduced p-cresyl sulfate generation rates and serum concentrations in hemodialysis patients (Meijers et al, 2010). However, an oral preparation of lactic acid bacteria did not reduce serum p-cresol concentrations in hemodialysis patients (Hida et al, 1996). Interestingly, the results of our preliminary study showed that synbiotics may be beneficial for decreased bacterial overgrowth and normal motility patterns in patients undergoing peritoneal dialysis and hemodialysis.…”

p-Cresyl Sulfate and Indoxyl Sulfate in Hemodialysis Patients

“…Residual renal function contributes little to total solute removal of protein-bound uremic retention solutes in HD patients (10). In this study, indoxyl sulfate and biotic-resistant lactic acid bacteria) reduced serum concentrations of indoxyl sulfate but not of p-cresyl sulfate in HD patients (27). Vice versa, we recently observed that intake of the prebiotic oligofructose-enriched inulin significantly reduced p-cresol generation and p-cresyl sulfate serum concentrations, whereas indoxyl sulfate serum concentrations were not systematically reduced, nor was the indole generation rate (clinicaltrials.gov NCT00695513) (28).…”

Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY)

“…with inulin (18). Furthermore, Hida et al (31) have previously reported that a probiotic-containing Bifidobacterium infantis, Lactobacillus acidophilus, and Enterococcus faecalis decreased serum IS after an increase in Bifidobacteriaceae and a decrease in the Enterobacteriaceae. Consequently, the ability of synbiotic formulations to reduce PCS and IS levels seems dependent on their Bifidogenic effects.…”