Skip to main content
SpringerLink
Log in

Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  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.

  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.

  7. Ayodele OE, Alebiosu CO. Burden of chronic kidney disease: an international perspective. Adv Chronic Kidney Dis. 2010;17:215–224.

    Article  PubMed  Google Scholar 

  8. Vanholder R, De Smet R, Glorieux G, et al. Review on uremic toxins: classification, concentration, and inter-individual variability. Kidney Int. 2003;63:1934–1943.

    Article  CAS  PubMed  Google Scholar 

  9. Ranganathan N. Probiotic dietary supplementation in patients with stage III and IV chronic kidney disease: a 6-month pilot scale trial in Canada. Curr Med Res Opin. 2009;25:1919–1930.

    Article  CAS  PubMed  Google Scholar 

  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.

    CAS  Google Scholar 

  12. Stig Benchmark: reviews - immunomodulation by pro- and prebiotics. Japan Bifidus Foundation. 2001;120:9–18.

  13. Sparks RE. Review of gastrointestinal perfusion in the treatment of uremia. Clin Nephrol. 1979;2:81–85.

    Google Scholar 

  14. Fuller R. Probiotics in human medicine. Gut. 1991;32:439–442.

    Article  CAS  PubMed  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.

    CAS  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.

    CAS  Google Scholar 

  18. Barbero GJ, Runge G, Fischer D, Crawford MN, Torres FE, Gyorgy P. Investigations of bacterial flora, pH and sugar content in the intestinal tract of infants. J Pediat. 1952;40:152–163.

    Article  CAS  PubMed  Google Scholar 

  19. Mata LJ. Intestinal colonization of breast-fed children in a rural area of low socioeconomic level. Ann N Y Acad Sci. 1971;176:93–109.

    Article  Google Scholar 

  20. Wynder EL. Colon cancer prevention. Cancer. 1977;40:2565–2571.

    Article  CAS  PubMed  Google Scholar 

  21. Donaldson RM. Normal bacterial populations of the intestine and their relation to intestinal function. N Engl J Med. 1964;270:1050–1056.

    Article  PubMed  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.

    CAS  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 Serbian

    Google Scholar 

  27. Kalouod H, Stogmann W. Clinical experience with a Bifidus milk feed. Arch Kinderheilk. 1968;177:29–35.

    Google Scholar 

  28. Mayer JB. Moglichkeiten einer phsiologischen antiviotischem therapie beim Saugling mit Bacterium bifidum (Lactobacillus Bifidus). Mschr Kinderheilk. 1966;114:67–73.

    CAS  PubMed  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.

  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 

  37. Vincent JG, Veomett RC, Riley RF. Antibacterial activity associated with Lactobacillus acidophilus. J Bacteriol. 1959;78:447–484.

    Article  Google Scholar 

  38. Sabine D. An antibiotic-like effect of lactobacillus acidophilus. Nature. 1963;199:811.

    Article  CAS  PubMed  Google Scholar 

  39. Dahiya RS, Speck ML. Hydrogen peroxide formation by Lactobacilli and its effect on Staphylococcus aureus. J Dairy Sci. 1968;51:1568–1572.

    Article  CAS  PubMed  Google Scholar 

  40. Wheater DM. Lactobacillin, an antibiotic from Lactobacilli. Nature. 1951;168:659.

    Article  CAS  Google Scholar 

  41. Dunn S, Simenhoff M, Ahmed K, et al. Effects of oral administration of freeze-dried lactobacillus acidophilus on small bowel bacterial overgrowth in patients with end stage kidney disease: Reducing uremic toxins and Improving Nutrition. Int Dairy J. 1998;8:454–553.

    Article  Google Scholar 

  42. Niwa T. Phenol and p-Cresol accumulated in uremic serum measured by HPLC with fluorescence detection. Clin Chem. 1993;39:108–111.

    CAS  PubMed  Google Scholar 

  43. Meydani SM, Ha W. Immunologic effects of yogurt. Am J Clin Nutr. 2000;71:861–872.

    CAS  PubMed  Google Scholar 

  44. Ranganathan N, Patel BG, Ranganathan P, et al. In vitro and in vivo assessment of intraintestinal bacteriotherapy in chronic kidney disease. ASAIO J. 2006;52:70–79

    Article  PubMed  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.

  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 

Download references

Author information

Authors and Affiliations

  1. Kibow Biotech, Inc., 629 West Chester Pike, Newtown Square, PA, 19073, USA

    Natarajan Ranganathan & Pari Ranganathan

  2. Downstate Medical Center, State University of New York (SUNY), Brooklyn, NY, USA

    Eli A. Friedman, Anthony Joseph & Barbara Delano

  3. New York Harbor VA Health Care System, NYU School of Medicine, New Tork, NY, USA

    David S. Goldfarb

  4. Corporate Medical Centre, Scarborough Hospital, Ontario, Canada

    Paul Tam

  5. Department of Nutritional Sciences, University of Toronto, Ontario, Canada

    A. Venketeshwer Rao

  6. The National Hospital, Abuja, Nigeria

    Emmanuel Anteyi

  7. Hospital taliano, Buenos Aires, Argentina

    Carlos Guido Musso

Authors
  1. Natarajan Ranganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pari Ranganathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eli A. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Delano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. David S. Goldfarb
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Tam
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Venketeshwer Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Emmanuel Anteyi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Carlos Guido Musso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natarajan Ranganathan.

Additional information

This article is published with open access at Springerlink.com

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ranganathan, N., Ranganathan, P., Friedman, E.A. et al. Pilot study of probiotic dietary supplementation for promoting healthy kidney function in patients with chronic kidney disease. Adv Therapy 27, 634–647 (2010). https://doi.org/10.1007/s12325-010-0059-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-010-0059-9

Keywords

Search

Navigation