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Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-analysis.
J Ren Nutr. 2019 05; 29(3):209-220.JR

Abstract

OBJECTIVE

Gut dysbiosis has been implicated in the pathogenesis of chronic kidney disease (CKD). Restoring gut microbiota with prebiotic, probiotic, and synbiotic supplementation has emerged as a potential therapeutic intervention but has not been systematically evaluated in the CKD population.

DESIGN AND METHODS

This is a systematic review. A structured search of MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and the International Clinical Trials Register Search Portal was conducted for articles published since inception until July 2017. Included studies were randomized controlled trials investigating the effects of prebiotic, probiotic, and/or synbiotic supplementation (>1 week) on uremic toxins, microbiota profile, and clinical and patient-centered outcomes in adults and children with CKD.

RESULTS

Sixteen studies investigating 645 adults met the inclusion criteria; 5 investigated prebiotics, 6 probiotics, and 5 synbiotics. The quality of the studies (Grades of Recommendation, Assessment, Development and Evaluation) ranged from moderate to very low. Prebiotic, probiotic, and synbiotic supplementation may have led to little or no difference in serum urea (9 studies, 345 participants: mean difference [MD] -0.30 mmol/L, 95% confidence interval [CI] -2.20 to 1.61, P = .76, I2 = 53%), indoxyl sulfate (4 studies, 144 participants: MD -0.02 mg/dL, 95% CI -0.09 to 0.05, P = .61, I2 = 0%), and p-cresyl sulfate (4 studies, 144 participants: MD -0.13 mg/dL, 95% CI -0.41 to 0.15, P = .35, I2 = 0%). Prebiotic supplementation may have slightly reduced serum urea concentration (4 studies, 105 participants: MD -2.23 mmol/L, 95% CI -3.83 to -0.64, P = .006, I2 = 11). Of the 2 studies investigating microbiota changes, synbiotic interventions significantly increased Bifidobacterium. Supplement effects on clinical outcomes were uncertain.

CONCLUSIONS

There is limited evidence to support the use of prebiotics, probiotics, and/or synbiotics in CKD management.

Authors+Show Affiliations

Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Renal Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia. Electronic address: catherine.mcfarlane3@health.qld.gov.au.Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Nutrition Programme, Federal University of Sao Paulo, Sao Paulo, Brazil; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, QLD, Australia.Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

30366767

Citation

McFarlane, Catherine, et al. "Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: a Systematic Review and Meta-analysis." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 29, no. 3, 2019, pp. 209-220.
McFarlane C, Ramos CI, Johnson DW, et al. Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-analysis. J Ren Nutr. 2019;29(3):209-220.
McFarlane, C., Ramos, C. I., Johnson, D. W., & Campbell, K. L. (2019). Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-analysis. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 29(3), 209-220. https://doi.org/10.1053/j.jrn.2018.08.008
McFarlane C, et al. Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: a Systematic Review and Meta-analysis. J Ren Nutr. 2019;29(3):209-220. PubMed PMID: 30366767.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prebiotic, Probiotic, and Synbiotic Supplementation in Chronic Kidney Disease: A Systematic Review and Meta-analysis. AU - McFarlane,Catherine, AU - Ramos,Christiane I, AU - Johnson,David W, AU - Campbell,Katrina L, Y1 - 2018/10/23/ PY - 2018/05/25/received PY - 2018/08/13/revised PY - 2018/08/13/accepted PY - 2018/10/28/pubmed PY - 2020/7/17/medline PY - 2018/10/28/entrez SP - 209 EP - 220 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 29 IS - 3 N2 - OBJECTIVE: Gut dysbiosis has been implicated in the pathogenesis of chronic kidney disease (CKD). Restoring gut microbiota with prebiotic, probiotic, and synbiotic supplementation has emerged as a potential therapeutic intervention but has not been systematically evaluated in the CKD population. DESIGN AND METHODS: This is a systematic review. A structured search of MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and the International Clinical Trials Register Search Portal was conducted for articles published since inception until July 2017. Included studies were randomized controlled trials investigating the effects of prebiotic, probiotic, and/or synbiotic supplementation (>1 week) on uremic toxins, microbiota profile, and clinical and patient-centered outcomes in adults and children with CKD. RESULTS: Sixteen studies investigating 645 adults met the inclusion criteria; 5 investigated prebiotics, 6 probiotics, and 5 synbiotics. The quality of the studies (Grades of Recommendation, Assessment, Development and Evaluation) ranged from moderate to very low. Prebiotic, probiotic, and synbiotic supplementation may have led to little or no difference in serum urea (9 studies, 345 participants: mean difference [MD] -0.30 mmol/L, 95% confidence interval [CI] -2.20 to 1.61, P = .76, I2 = 53%), indoxyl sulfate (4 studies, 144 participants: MD -0.02 mg/dL, 95% CI -0.09 to 0.05, P = .61, I2 = 0%), and p-cresyl sulfate (4 studies, 144 participants: MD -0.13 mg/dL, 95% CI -0.41 to 0.15, P = .35, I2 = 0%). Prebiotic supplementation may have slightly reduced serum urea concentration (4 studies, 105 participants: MD -2.23 mmol/L, 95% CI -3.83 to -0.64, P = .006, I2 = 11). Of the 2 studies investigating microbiota changes, synbiotic interventions significantly increased Bifidobacterium. Supplement effects on clinical outcomes were uncertain. CONCLUSIONS: There is limited evidence to support the use of prebiotics, probiotics, and/or synbiotics in CKD management. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/30366767/Prebiotic_Probiotic_and_Synbiotic_Supplementation_in_Chronic_Kidney_Disease:_A_Systematic_Review_and_Meta_analysis_ DB - PRIME DP - Unbound Medicine ER -