Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 469–479 | Cite as

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

  • Charat Thongprayoon
  • Wisit Kaewput
  • Spencer T. Hatch
  • Tarun Bathini
  • Konika Sharma
  • Karn Wijarnpreecha
  • Patompong Ungprasert
  • Matthew D’Costa
  • Michael A. Mao
  • Wisit CheungpasitpornEmail author
Original Article



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.


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.


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.


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.


Probiotics Gut microbiome End-stage renal disease ESRD Dialysis Uremic toxins 


Author’s contribution

All authors had access to the data and a role in writing the manuscript.

Compliance with ethical standards

Conflict of interest

We do not have any financial or non-financial potential conflicts of interest.

Supplementary material

10620_2018_5243_MOESM1_ESM.doc (42 kb)
Supplementary material 1 (DOC 42 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Charat Thongprayoon
    • 1
  • Wisit Kaewput
    • 3
  • Spencer T. Hatch
    • 2
  • Tarun Bathini
    • 1
  • Konika Sharma
    • 1
  • Karn Wijarnpreecha
    • 1
  • Patompong Ungprasert
    • 4
  • Matthew D’Costa
    • 5
  • Michael A. Mao
    • 5
  • Wisit Cheungpasitporn
    • 2
    Email author
  1. 1.Department of Internal MedicineBassett Medical CenterCooperstownUSA
  2. 2.Division of Nephrology, Department of MedicineUniversity of Mississippi Medical CenterJacksonUSA
  3. 3.Department of Military and Community MedicinePhramongkutklao College of MedicineBangkokThailand
  4. 4.Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  5. 5.Division of Nephrology and Hypertension, Department of MedicineMayo ClinicRochesterUSA

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