Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease
- 791 Downloads
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
Unable to display preview. Download preview PDF.
- 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