December 31, 2018
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Probiotics may reduce urea in patients with non-dialysis CKD

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Probiotic supplements are generally beneficial in the reduction of urea in patients with non-dialysis chronic kidney disease, whereas no evidence suggested that probiotics possessed meaningful impacts on the reduction of uric acid, C-reactive protein, creatinine and eGFR preservation of CKD population.

“Gut microbiota played key roles in the urea hydrolysis to produce the majority of fecal ammonium, while the urea and ammonium concentrations were closely related to the progression of CKD,” Sibei Tao, MD, and colleagues wrote. “Consequently, the elevated gut pH and increased aerobic bacteria were exposed to the relatively high urea and ammonium concentrations. Interestingly, probiotics have been reported to prevent the growth of aerobic bacteria and normalize intestinal microbiota in CKD patients [36], which could explain the urea decrease in non-dialysis CKD population.”

The researchers noted the potential for probiotics to reduce uremic toxins, which may hinder CKD progression. They also underscored that no individual probiotic could be expected to inherently have all necessary effects for reduction because organisms might behave differently when applied as a single strain vs. a combination of probiotic strains.

Patients in the studies assessed were diagnosed with CKD, whether undergoing dialysis or not, and those in intervention groups had to receive probiotics in any form, at any dose and for any duration. Patients in control groups had to receive placebo for comparison, and studies reported an outcome that included either urea, uric acid, C-reactive protein, creatinine or eGFR.

Limitations of the meta-analysis, according to the authors, include different diets, diversity of strains and a limited number of probiotic species.

“Further studies are needed to assess the effect of long-term administration of probiotics on clinical outcomes in CKD,” the researchers wrote. “Strict control of diet and selection of strains should be emphasized. Well-designed studies and cost-effective analyses are also necessary to explore the full potential of probiotics on CKD.” – by Joe Gramigna