Effects of Probiotics on Inflammation and Uremic Toxins Among Patients on Dialysis: A Systematic Review and Meta-Analysis.
Dialysis
ESRD
End-stage renal disease
Gut microbiome
Probiotics
Uremic toxins
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
16
06
2018
accepted:
06
08
2018
pubmed:
14
8
2018
medline:
26
3
2019
entrez:
13
8
2018
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND/OBJECTIVES
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Identifiants
pubmed: 30099652
doi: 10.1007/s10620-018-5243-9
pii: 10.1007/s10620-018-5243-9
doi:
Substances chimiques
Serum Albumin
0
Tumor Necrosis Factor-alpha
0
C-Reactive Protein
9007-41-4
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
469-479Commentaires et corrections
Type : CommentIn
Références
Nephrol Dial Transplant. 2002 Aug;17(8):1434-9
pubmed: 12147791
Curr Diab Rep. 2017 Mar;17(3):16
pubmed: 28271466
Kidney Int. 2013 Jun;83(6):1010-6
pubmed: 23325079
Nephrol Dial Transplant. 2015 Jun;30(6):924-33
pubmed: 25190600
J Am Soc Nephrol. 2017 May;28(5):1450-1461
pubmed: 27927779
Nephrol Dial Transplant. 2011 Mar;26(3):1094-8
pubmed: 20929916
Adv Ther. 2010 Sep;27(9):634-47
pubmed: 20721651
Control Clin Trials. 1986 Sep;7(3):177-88
pubmed: 3802833
PLoS One. 2014 Sep 22;9(9):e108448
pubmed: 25244654
Curr Opin Nephrol Hypertens. 2016 Nov;25(6):570-576
pubmed: 27517135
Probiotics Antimicrob Proteins. 2018 Sep;10(3):466-477
pubmed: 29464501
Nutrition. 2018 Jul - Aug;51-52:104-113
pubmed: 29626749
ScientificWorldJournal. 2005 Aug 24;5:652-60
pubmed: 16127597
Benef Microbes. 2015;6(4):423-30
pubmed: 25609654
PLoS Pathog. 2010 Jan;6(1):e1000711
pubmed: 20062525
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Am J Gastroenterol. 2007 Sep;102(9):1990-7
pubmed: 17511755
Mol Nutr Food Res. 2013 May;57(5):824-32
pubmed: 23450842
Nutr Hosp. 2014 Mar 01;29(3):582-90
pubmed: 24559003
Nature. 2016 Jul 06;535(7610):47
pubmed: 27383978
ASAIO J. 2006 Jan-Feb;52(1):70-9
pubmed: 16436893
Pharmacol Res. 2018 Apr;130:143-151
pubmed: 29444477
PLoS Med. 2007 Oct 16;4(10):e296
pubmed: 17941714
Biomed Res Int. 2014;2014:568571
pubmed: 25147806
J Ren Nutr. 2014 Sep;24(5):330-5
pubmed: 25066654
Biol Chem. 2015 Nov;396(11):1181-97
pubmed: 26040008
Am J Med Sci. 2017 Jan;353(1):59-69
pubmed: 28104104
Curr Med Res Opin. 2009 Aug;25(8):1919-30
pubmed: 19558344
Clin Exp Nephrol. 2017 Feb;21(1):7-15
pubmed: 26965149
Pharmacol Res. 2018 Apr;130:152-163
pubmed: 29410236
Biomed Pharmacother. 2017 Jun;90:229-236
pubmed: 28363168
Nephrol Dial Transplant. 2018 Jan 1;33(1):4-12
pubmed: 28407121
Curr Opin Nephrol Hypertens. 2012 Nov;21(6):587-92
pubmed: 23010760
J Am Soc Nephrol. 2015 Aug;26(8):1877-88
pubmed: 25589612
Cochrane Database Syst Rev. 2015 Dec 23;(12):CD008772
pubmed: 26695595
Kidney Int. 2005 Sep;68(3):1244-9
pubmed: 16105057
Kidney Int. 2016 Dec;90(6):1191-1198
pubmed: 27575555
Nefrologia. 2017 Jan - Feb;37(1):9-19
pubmed: 27553986
Circ Res. 2015 Jan 30;116(3):448-55
pubmed: 25599331
Iran J Kidney Dis. 2016 Nov;10(6):351-357
pubmed: 27903994
Clin J Am Soc Nephrol. 2016 Feb 5;11(2):223-31
pubmed: 26772193
Clin Sci (Lond). 2018 Mar 9;132(5):509-522
pubmed: 29523750
Gut. 2006 Feb;55(2):205-11
pubmed: 16188921
Toxins (Basel). 2018 Jul 11;10(7):
pubmed: 29997362
Am J Nephrol. 2014;39(3):230-237
pubmed: 24643131
Nephron Clin Pract. 2014;127(1-4):139-43
pubmed: 25343838
Pediatr Nephrol. 2017 Nov;32(11):2005-2014
pubmed: 27848096
Ann Nutr Metab. 2017;71(3-4):242-246
pubmed: 29136611
Adv Appl Microbiol. 2010;72:63-87
pubmed: 20602988
Clin J Am Soc Nephrol. 2016 Feb 5;11(2):199-201
pubmed: 26772192
Kidney Int. 2017 Feb;91(2):435-442
pubmed: 27927601
Am J Nephrol. 2018;47(5):325-332
pubmed: 29779028
Pharmacol Res. 2019 Jun;144:390-408
pubmed: 29378252
Aliment Pharmacol Ther. 2015 Nov;42(9):1051-63
pubmed: 26304302
PLoS One. 2015 Jul 07;10(7):e0132970
pubmed: 26151753
G Ital Nefrol. 2017 Dec 05;34(Nov-Dec):
pubmed: 29207222
Future Microbiol. 2014;9(3):399-410
pubmed: 24762311
Pharmacol Res. 2018 Apr;130:198-203
pubmed: 29496593
Nephrology (Carlton). 2014 Aug;19(8):500-6
pubmed: 24787732
Minerva Urol Nefrol. 2016 Apr;68(2):222-6
pubmed: 24990390
Diabetes Care. 2017 Jan;40(Suppl 1):S99-S104
pubmed: 27979898
Clin Kidney J. 2015 Jun;8(3):332-4
pubmed: 26034597
Aliment Pharmacol Ther. 2018 Apr;47(8):1054-1070
pubmed: 29460487
Nature. 2016 Jul 06;535(7610):48-55
pubmed: 27383979
Clin J Am Soc Nephrol. 2014 Feb;9(2):430-4
pubmed: 24202130
Nat Med. 1996 Aug;2(8):883-7
pubmed: 8705857
Pediatr Nephrol. 2017 Jun;32(6):921-931
pubmed: 27129691
Aliment Pharmacol Ther. 2013 Oct;38(8):864-86
pubmed: 23981066
Rev Infect Dis. 1984 Mar-Apr;6 Suppl 1:S222-8
pubmed: 6372032
J Ren Nutr. 2015 May;25(3):284-91
pubmed: 25455039
J Am Soc Nephrol. 2014 Apr;25(4):657-70
pubmed: 24231662
Semin Dial. 2015 Sep-Oct;28(5):459-63
pubmed: 25855516
Lancet. 1991 Apr 13;337(8746):867-72
pubmed: 1672966
BMC Nephrol. 2014 Jul 04;15:106
pubmed: 24996842
Am J Transplant. 2013 Apr;13(4):829
pubmed: 23551627
J Am Soc Nephrol. 2011 Sep;22(9):1769-76
pubmed: 21784895
J Ren Nutr. 2011 Nov;21(6):448-54
pubmed: 21239186
Adv Chronic Kidney Dis. 2014 Jul;21(4):377-84
pubmed: 24969391
J Am Soc Nephrol. 2009 Jun;20(6):1199-209
pubmed: 19470680
Kidney Int. 2013 Apr;83(4):582-92
pubmed: 23325087
J Ren Nutr. 2015 Sep;25(5):399-403
pubmed: 25812908
Kidney Int. 2015 Nov;88(5):958-66
pubmed: 26376131
Nutr Metab Cardiovasc Dis. 2014 Sep;24(9):1043-9
pubmed: 24929795
Miner Electrolyte Metab. 1996;22(1-3):92-6
pubmed: 8676836
Probiotics Antimicrob Proteins. 2019 Jun;11(2):648-654
pubmed: 29651635
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120