The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial

Soleimani, Alireza; Motamedzadeh, Alireza; Mojarrad, Malihe Zarrati; Bahmani, Fereshteh; Amirani, Elaheh; Ostadmohammadi, Vahidreza; Tajabadi‐Ebrahimi, Maryam; Asemi, Zatollah

doi:10.1007/s12602-018-9499-3

Cited by 47 publications

(36 citation statements)

References 51 publications

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“…In this present study, synbiotic therapy was deemed acceptable by study participants with a high level of adherence and tolerance to treatment. Similar findings have been reported in other synbiotic interventions with adherence ranging from 82 to 94% [8,24,25], with minimal gastrointestinal side effects reported [26].…”

Section: Discussionsupporting

confidence: 87%

Synbiotics Easing Renal Failure by Improving Gut Microbiology II (SYNERGY II): A Feasibility Randomized Controlled Trial

et al. 2021

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Synbiotics have emerged as a therapeutic strategy for modulating the gut microbiome and targeting novel cardiovascular risk factors, including uremic toxins indoxyl sulfate (IS) and p-cresyl sulfate (PCS). This study aims to evaluate the feasibility of a trial of long-term synbiotic supplementation in adults with stage 3–4 chronic kidney disease (CKD). Adult participants with CKD and estimated glomerular filtration rate (eGFR) of 15–60 mL/min/1.73 m2) were recruited between April 2017 and August 2018 to a feasibility, double-blind, placebo-controlled, randomized trial of synbiotic therapy or matched identical placebo for 12 months. The primary outcomes were recruitment and retention rates as well as acceptability of the intervention. Secondary outcomes were treatment adherence and dietary intake. Exploratory outcomes were evaluation of the cardiovascular structure and function, serum IS and PCS, stool microbiota profile, kidney function, blood pressure, and lipid profile. Of 166 potentially eligible patients, 68 (41%) were recruited into the trial (synbiotic n = 35, placebo n = 33). Synbiotic and placebo groups had acceptable and comparable 12-month retention rates (80% versus 85%, respectively, p = 0.60). Synbiotic supplementation altered the stool microbiome with an enrichment of Bifidobacterium and Blautia spp., resulting in a 3.14 mL/min/1.73 m2 (95% confidence interval (CI), −6.23 to −0.06 mL/min/1.73 m2, p < 0.01) reduction in eGFR and a 20.8 µmol/L (95% CI, 2.97 to 38.5 µmol/L, p < 0.01) increase in serum creatinine concentration. No between-group differences were observed in any of the other secondary or exploratory outcomes. Long-term synbiotic supplementation was feasible and acceptable to patients with CKD, and it modified the gastrointestinal microbiome. However, the reduction in kidney function with synbiotics warrants further investigation.

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Section: Discussionsupporting

confidence: 87%

Synbiotics Easing Renal Failure by Improving Gut Microbiology II (SYNERGY II): A Feasibility Randomized Controlled Trial

et al. 2021

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“…bulgaricus , S. thermophilus , L. paracasei ssp . paracasei (2.4×10 9 CFU per day) 113 Adults with T1DM and T2DM on haemodialysis, n = 60 Inulin (0.8 g per day) L. acidophilus , L. casei , B. bifidum (2×10 9 CFU of each per day) 114 Treatment of irritable bowel syndrome Adults, n = 85 FOS (100 mg, three times per day) Bacillus coagulans (15×10 7 spores, three times per day) 115 Children, n = 71 Inulin (900 mg, twice per day) B. lactis B94 (5×10 9 CFU, twice per day) 116 Eradication of Helicobacter pylori Adults, n = 76 FOS (250 mg per day) L. casei PXN 37, L. rhamnosus PXN 54, S. thermophilus PXN 66, B. breve PXN 25, L. acidophilus PXN 35, B. longum PXN 30, L. bulgaricus PXN 39 (2×10 8 CFU per day) 117 Children and youth, n = 104 Inulin (900 mg per day) B. lactis B94 (5×10 9 CFU per day) 118 Treatment of polycystic ovarian syndrome Adults, n = 60 Inulin (800 mg per day) L. acidophilus strain T16 (IBRC-M10785), L. casei strain T2 (IBRC-M10783), B. bifidum strain T1 (IBRC-M10771) (2×10 9 CFU/g of each per day) 119 Adults, n = 60 Inulin (800 mg per day) L. acidophilus strain T16 (IBRC-M10785), L. casei strain T2 (IBRC-M10783), B. bifidum strain T1 (IBRC-M10771) (2×10 9 CFU/g of each per day) 120 Treatment of chronic kidney disease Adults, n = 30 Inulin (2.2 g), tapioca-resistant starch (1.3 g) (three times per day) L. plantarum (5×10 9 ), L. casei subsp. r hamnosus (2×10 9 ), Lactobacillus gasseri (2×10 ...…”

Section: Current Levels Of Evidencementioning

confidence: 99%

The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics

Swanson

Gibson

Hutkins

et al. 2020

Nat Rev Gastroenterol Hepatol

1,101

455

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In May 2019, the International Scientific Association for Probiotics and Prebiotics (ISAPP) convened a panel of nutritionists, physiologists and microbiologists to review the definition and scope of synbiotics. The panel updated the definition of a synbiotic to “a mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host”. The panel concluded that defining synbiotics as simply a mixture of probiotics and prebiotics could suppress the innovation of synbiotics that are designed to function cooperatively. Requiring that each component must meet the evidence and dose requirements for probiotics and prebiotics individually could also present an obstacle. Rather, the panel clarified that a complementary synbiotic, which has not been designed so that its component parts function cooperatively, must be composed of a probiotic plus a prebiotic, whereas a synergistic synbiotic does not need to be so. A synergistic synbiotic is a synbiotic for which the substrate is designed to be selectively utilized by the co-administered microorganisms. This Consensus Statement further explores the levels of evidence (existing and required), safety, effects upon targets and implications for stakeholders of the synbiotic concept.

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“…Seven trials tested prebiotics 18,30,31,35,37,40,41 seven trials tested probiotics 15,17,22,29,33,34,36,39 , while six trials tested synbiotics 16,19,20,23,28,32,38 , and one trial 13,14 tested both probiotics and synbiotics. Eighteen trials were parallel-group randomised controlled trials, while three were randomised controlled crossover trials (Table 1).…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

“…However these reviews are limited by the fact that they have pooled randomised and nonrandomised trials together 11 , not performed a meta-analysis 8 , or pooled individuals with CKD receiving and not receiving dialysis 9,10 . Lastly and most notably there has been a number of recent experimental investigations in the area [13][14][15][16][17][18][19][20] . Therefore, the primary aim of this systematic review is to provide an up-to date assessment of the efficacy and safety of prebiotic, probiotic and synbiotic oral supplementation in reducing circulating endotoxin, indoxyl-sulphate and p-cresyl sulphate in ESRD individuals receiving haemodialysis and PD.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

March

Jones

Bishop

et al. 2020

Journal of Renal Nutrition

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The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial

Cited by 47 publications

References 51 publications

Synbiotics Easing Renal Failure by Improving Gut Microbiology II (SYNERGY II): A Feasibility Randomized Controlled Trial

Synbiotics Easing Renal Failure by Improving Gut Microbiology II (SYNERGY II): A Feasibility Randomized Controlled Trial

The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of synbiotics

The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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