Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease
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Uremic syndrome consists of nitrogenous waste retention, deficiency in kidney-derived hormones, and reduced acid excretion, and, if untreated, may progress to coma and eventual death. Previous experience suggests that oral administration of a probiotic formulation of selected microbial strains may extend renoprotection via intraintestinal extraction of toxic waste solutes in patients with chronic kidney disease (CKD)stages 3 and 4. This report presents preliminary data from a pilot study.
This was a 6-month prospective, randomized, double-blind, placebo-controlled crossover trial of a probiotic bacterial formulation conducted in four countries, at five institutions, on 46 outpatients with CKD stages 3 an nd 4: USA (n=10), Canada (n=113), Nigeria (n=115), and Argentina (n=8). Outcomes were compared using biochemical parameters:blood urea nitrogen (BUN), serum creatinine, and uric acid. General well-being was assessed as a secondary parameter by a quality of life (QQOL) questionnaire on a subjective scale of 1–10.
Oral ingestion of probiotics (90 billion colony forming units [CFUs]/day) was well tolerated and safe during the entire trial period at all sites. BUN levels decreased in 29 patients (63%, P<0.05), creatinine levels decreased in 20 patients (43%, no statistical significance), and uric acid levels decreased in 15 patients (33%, no statistical significance). Almost all subjects expressed a perceived substantial overall improvement in QOL (86%, P<0.05).
The main outcomes of this preliminary trial include a significant reduction of BUN, enhanced well-being, and absence of serious adverse effects, thus supporting the use of the chosen probiotic formulation for bowel-based toxic solute extraction. QOL and BUN levels showed statistically significant differences in outcome (P<0.05) between placebo and probiotic treatment periods at all four sites (46 patients). A major limitation of this trial is the small sample size nd elated inconsistencies.
Keywordschronic kidney disease disease progression healthy kidney probiotics renoprotection uremic syndrome
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- 1.Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food London, Ontario, Canada, April 30–May 1, 2002.Google Scholar
- 2.Sherman M. Probiotics and microflora. US Pharmacist. 2009;34:42–44.Google Scholar
- 3.Lee Y-K, Salminen S. The coming of age of probiotics. TIFST. 1995;6:241–245.Google Scholar
- 4.Murthy M. Delineation of beneficial characteristics of effective probiotics. JAMA. 2000;3:38–43.Google Scholar
- 5.Reddy SB. Possible mechanisms by which proand prebiotics influence colon carcinogenesis and tumor growth. J Nutr. 1999;129(7 suppl.):1478S–1482S.Google Scholar
- 6.USRDS 2009 Annual Data Report. United States Renal Data System web site. Available at: www.usrds.org/adr.htm. Accessed November 1, 2009.
- 10.Drasar BS, Roberts AK. Chapter 3: Control of the large bowel bowel microflora. The adult climax microflora. In: Human Microbial Ecology. Hill MJ, Marsh PD, editors. Boca Raton, FL: CRC Press, Inc.; 1990:93–103.Google Scholar
- 11.Reuter G. Lactobacilli and Bifidobacterium microflora of the human intestine: composition and succession. Curr Issues Intest Microbial. 2001;2:43–53.Google Scholar
- 12.Stig Benchmark: reviews - immunomodulation by pro- and prebiotics. Japan Bifidus Foundation. 2001;120:9–18.Google Scholar
- 13.Sparks RE. Review of gastrointestinal perfusion in the treatment of uremia. Clin Nephrol. 1979;2:81–85.Google Scholar
- 15.Speck ML. Contributions of microorganisms to foods and nutrition. Nutr News. 1975;38:13.Google Scholar
- 16.Alm L. The effect of Lactobacillus acidophilus administration upon survival of salmonella in randomly selected human carriers. Prog Ed Nutr Sci. 1983;7:13–17.Google Scholar
- 17.Clements ML. Exogenous lactobacilli fed to mantheir fate and ability to prevent diarrheal disease. Prog Ed Nutr Sci. 1983;7:29–37.Google Scholar
- 22.Shahani KM, Ayebo AD. Role of dietary lactobacilli in gastrointestinal microecology. Am J Clin Nutr. 1980;32:2448–2457.Google Scholar
- 23.Gilliland SE. Antagonistic action of Lactobacillus acidophilus toward intestinal and food borne pathogens in associative cultures. J Food Prot. 1997;40:820–823.Google Scholar
- 24.Sherwood L, Nahas L. Lerner PI, Weinstein L. Studies of intestinal microflora I: effects of diet, age, and periodic sampling on numbers of fecal microorganisms in man. Gastroenterology. 1967;53:845–855.Google Scholar
- 25.Costerton JW, Rozee KR, Cheng KJ. Colonization of particulates, mucous, and intestinal tissue. Prog Ed Nutr Sci. 1983;7:91–105.Google Scholar
- 26.Tasovac B, Kocic A. Lactobacillus acidophilus flora and its effect in preventing infant entercolitis. Srp Arh Celok Lek. 1970;98:2019–2028. Article in SerbianGoogle Scholar
- 27.Kalouod H, Stogmann W. Clinical experience with a Bifidus milk feed. Arch Kinderheilk. 1968;177:29–35.Google Scholar
- 29.Mayer JB. Interrelationships between diet, intestinal flora and viruses. Phys Med Rehab. 1969;10:16–23.Google Scholar
- 30.Reyed MR. The Role of Bifidobacteria in health. Res J Med Med Sci. 2007;2:14–27.Google Scholar
- 31.Schauss AG. Lactobacillus acidophilus: Methods of action, clinical application, and toxicity data. J Adv Med. 1990;3:163–178.Google Scholar
- 32.Simon GL, Gorbach SL. Intestinal flora in health and disease. In: Physiology of the Gastrointestinal Tract. New York: Raven Press; 1981:1361–1369.Google Scholar
- 33.Rasic JLJ, Kurmann JA. Bifidobacteria and their Role. Basel, Switzerland: Birkhauser Verlag; 1983.Google Scholar
- 34.Blom H, Mortvedt C. Anti-microbial substances produced by food associated micro-organisms. Biochem Soc Trans-Food Biotech. 1991;694–698.Google Scholar
- 35.Daeschel MA. Applications of bacteriocins in food systems. In: Biotechnology and Food Safety. Boston, MA: Butterworth-Heinemann; 1990:91–104.Google Scholar
- 36.Shanai KM. Natural antibiotic activity of Lactobacillus acidophilus and Bulagricus II. Isolation of acidophilin from L. acidophilus. Cult Dairy Prod J. 1977;12:8.Google Scholar
- 45.Ranganathan N, Patel B, Ranganathan P, et al. Probiotic amerlioration of azotemia in 5/6th nephrectomized Sprague-Dawley rats. Sci World J. 2005;5:652–660.Google Scholar
- 46.Patel B, Marczely J, Ranganathan N, Handa R, Willis LR, Friedman EA. Gut-based uremia therapy: oral bacteriotherapy effectively reduces severity of azotemia in 5/6th nephrectomized mini pigs. Presented at: International Society of Nephrology Conference on Prevention of Progression of Renal Disease, Hong Kong, June 2004. Poster #72111.Google Scholar
- 47.Palmquist R. A preliminary clinical evaluation of Kibow Biotics, a probiotic agent, on feline azotemia. J Am Vet Med Assoc. 2006;2:23–27.Google Scholar