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Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis.
Clin Ther. 2021 03; 43(3):e71-e96.CT

Abstract

PURPOSE

Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic, and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. A systematic review and meta-analysis was performed to evaluate the effectiveness of probiotic, prebiotic, and synbiotic supplementation for improving cardiometabolic and oxidative stress parameters in patients with CKD.

METHODS

A comprehensive key word search was performed in EMBASE, Medline, Scopus, Cochrane Central, and Web of Science until April 2020. Randomized controlled trials investigating the effectiveness of probiotic, synbiotic, and prebiotic supplementation for the management of adults with CKD were included. Primary outcomes were measures of cardiometabolic parameters such as cholesterol and fasting blood glucose. Secondary outcomes were measures of oxidative stress (eg, malondialdehyde levels) and body mass index. Random effects meta-analyses were used to estimate mean treatment effects. Results are reported as standardized mean differences (SMDs) and 95% CIs.

FINDINGS

Fourteen articles were included. In patients with CKD, probiotic, prebiotic, and synbiotic supplementation significantly reduced total cholesterol (SMD, -0.25; 95% CI, -0.46 to -0.04; I2 = 00.0%), fasting blood glucose (SMD, -0.41; 95% CI, -0.65 to -0.17; I2 = 00.0%), homeostatic model assessment of insulin resistance (SMD, -0.63; 95% CI, -0.95 to -0.30; I2 = 43.3%), insulin levels (SMD, -0.49; 95% CI, -0.90 to -0.08; I2 = 65.2%), high-sensitivity C-reactive protein levels (SMD, -0.52; 95% CI, -0.81 to -0.22; I2 = 52.7%), and malondialdehyde levels (SMD, -0.79; 95% CI, -1.22 to -0.37; I2 = 69.8%) compared with control interventions. Supplementation significantly increased the quantitative insulin sensitivity check index (SMD, 0.78; 95% CI, 0.51 to 1.05; I2 = 00.0%), total antioxidant capacity (SMD, 0.42; 95% CI, 0.18 to 0.66; I2 = 00.0%), and glutathione levels (SMD, 0.52; 95% CI, 0.19 to 0.86; I2 = 37.0%).

IMPLICATIONS

Probiotic, prebiotic, and synbiotic supplementation seems to be a promising intervention for improving cardiometabolic and oxidative stress parameters in patients with CKD.

Authors+Show Affiliations

Pediatric Nephrology Research Center, Research Institute for Children's Health, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.Department of Nutrition and Public Health, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd Iran.College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom.Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran. Electronic address: Javad.Heshmati@gmail.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33526314

Citation

Bakhtiary, Mahsa, et al. "Effect of Probiotic, Prebiotic, and Synbiotic Supplementation On Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: a Systematic Review and Meta-analysis." Clinical Therapeutics, vol. 43, no. 3, 2021, pp. e71-e96.
Bakhtiary M, Morvaridzadeh M, Agah S, et al. Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. Clin Ther. 2021;43(3):e71-e96.
Bakhtiary, M., Morvaridzadeh, M., Agah, S., Rahimlou, M., Christopher, E., Zadro, J. R., & Heshmati, J. (2021). Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. Clinical Therapeutics, 43(3), e71-e96. https://doi.org/10.1016/j.clinthera.2020.12.021
Bakhtiary M, et al. Effect of Probiotic, Prebiotic, and Synbiotic Supplementation On Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: a Systematic Review and Meta-analysis. Clin Ther. 2021;43(3):e71-e96. PubMed PMID: 33526314.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Probiotic, Prebiotic, and Synbiotic Supplementation on Cardiometabolic and Oxidative Stress Parameters in Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. AU - Bakhtiary,Mahsa, AU - Morvaridzadeh,Mojgan, AU - Agah,Shahram, AU - Rahimlou,Mehran, AU - Christopher,Edward, AU - Zadro,Joshua R, AU - Heshmati,Javad, Y1 - 2021/01/30/ PY - 2020/06/03/received PY - 2020/12/15/revised PY - 2020/12/29/accepted PY - 2021/2/3/pubmed PY - 2021/10/16/medline PY - 2021/2/2/entrez KW - cardiometabolic KW - chronic kidney disease KW - oxidative stress KW - probiotic SP - e71 EP - e96 JF - Clinical therapeutics JO - Clin Ther VL - 43 IS - 3 N2 - PURPOSE: Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic, and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. A systematic review and meta-analysis was performed to evaluate the effectiveness of probiotic, prebiotic, and synbiotic supplementation for improving cardiometabolic and oxidative stress parameters in patients with CKD. METHODS: A comprehensive key word search was performed in EMBASE, Medline, Scopus, Cochrane Central, and Web of Science until April 2020. Randomized controlled trials investigating the effectiveness of probiotic, synbiotic, and prebiotic supplementation for the management of adults with CKD were included. Primary outcomes were measures of cardiometabolic parameters such as cholesterol and fasting blood glucose. Secondary outcomes were measures of oxidative stress (eg, malondialdehyde levels) and body mass index. Random effects meta-analyses were used to estimate mean treatment effects. Results are reported as standardized mean differences (SMDs) and 95% CIs. FINDINGS: Fourteen articles were included. In patients with CKD, probiotic, prebiotic, and synbiotic supplementation significantly reduced total cholesterol (SMD, -0.25; 95% CI, -0.46 to -0.04; I2 = 00.0%), fasting blood glucose (SMD, -0.41; 95% CI, -0.65 to -0.17; I2 = 00.0%), homeostatic model assessment of insulin resistance (SMD, -0.63; 95% CI, -0.95 to -0.30; I2 = 43.3%), insulin levels (SMD, -0.49; 95% CI, -0.90 to -0.08; I2 = 65.2%), high-sensitivity C-reactive protein levels (SMD, -0.52; 95% CI, -0.81 to -0.22; I2 = 52.7%), and malondialdehyde levels (SMD, -0.79; 95% CI, -1.22 to -0.37; I2 = 69.8%) compared with control interventions. Supplementation significantly increased the quantitative insulin sensitivity check index (SMD, 0.78; 95% CI, 0.51 to 1.05; I2 = 00.0%), total antioxidant capacity (SMD, 0.42; 95% CI, 0.18 to 0.66; I2 = 00.0%), and glutathione levels (SMD, 0.52; 95% CI, 0.19 to 0.86; I2 = 37.0%). IMPLICATIONS: Probiotic, prebiotic, and synbiotic supplementation seems to be a promising intervention for improving cardiometabolic and oxidative stress parameters in patients with CKD. SN - 1879-114X UR - https://www.unboundmedicine.com/medline/citation/33526314/Effect_of_Probiotic_Prebiotic_and_Synbiotic_Supplementation_on_Cardiometabolic_and_Oxidative_Stress_Parameters_in_Patients_With_Chronic_Kidney_Disease:_A_Systematic_Review_and_Meta_analysis_ DB - PRIME DP - Unbound Medicine ER -