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Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis

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Abstract

Background/Objectives

We performed this systematic review and meta-analysis to evaluate effects of probiotics on inflammation, uremic toxins, and gastrointestinal (GI) symptoms in end-stage renal disease (ESRD) patients.

Methods

A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane Database from inception through October 2017. We included studies that assessed assessing effects of probiotics on inflammatory markers, protein-bound uremic toxins (PBUTs), and GI symptoms in ESRD patients on dialysis. Effect estimates from the individual study were extracted and combined utilizing random effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO; No. CRD42017082137.

Results

Seven clinical trials with 178 ESRD patients were enrolled. There was a significant reduction in serum C-reactive protein (CRP) from baseline to post-probiotic course (≥ 2 months after treatment) with standardized mean difference (SMD) of − 0.42 (95% CI − 0.68 to − 0.16, p = 0.002). When compared to control, patients who received probiotics also had a significant higher degree of reduction in CRP level with SMDs of − 0.37 (95% CI − 0.72 to 0.03, p = 0.04). However, there were no significant changes in serum TNF-alpha or albumin with SMDs of − 0.32 (95% CI − 0.92 to 0.28, p = 0.29) and 0.16 (95% CI − 0.20 to 0.53, p = 0.39), respectively. After probiotic course, there were also significant decrease in PBUTs and improvement in overall GI symptoms (reduction in GI symptom scores) with SMDs of − 0.61 (95% CI − 1.16 to − 0.07, p = 0.03) and − 1.04 (95% CI − 1.70 to − 0.38, p = 0.002), respectively.

Conclusion

Our study demonstrates potential beneficial effects of probiotics on inflammation, uremic toxins, and GI Symptoms in ESRD patients. Future large-scale clinical studies are required to assess its benefits on other important clinical outcomes including patient mortality.

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Authors and Affiliations

  1. Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA

    Charat Thongprayoon, Tarun Bathini, Konika Sharma & Karn Wijarnpreecha

  2. Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, 2500 N. State St., Jackson, MS, 39216, USA

    Spencer T. Hatch & Wisit Cheungpasitporn

  3. Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand

    Wisit Kaewput

  4. Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Patompong Ungprasert

  5. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    Matthew D’Costa & Michael A. Mao

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  1. Charat Thongprayoon
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Thongprayoon, C., Kaewput, W., Hatch, S.T. et al. Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis. Dig Dis Sci 64, 469–479 (2019). https://doi.org/10.1007/s10620-018-5243-9

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