The efficacy of probiotics, synbiotics and prebiotics in the management of chronic renal disease: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background: Chronic kidney disease (CKD) is a progressive and irreversible loss of kidney function. It is estimated to affect 18.2% of people aged 60 years or older. Intestinal dysbiosis is common among patients with CKD and it may affect the progression of the disease and related complications. CKD presents a considerable burden and an increased risk of mortality and morbidity. Strategies to improve the quality of life for patients with CKD by managing the associated symptoms and complications are still limited. Aim: Examine the effect of probiotics, prebiotics and synbiotics on renal parameters and uremic toxins and other outcomes including a lipid profile and gastrointestinal symptoms. Methods: The PubMed and Cochrane Central Register of Controlled Trials electronic databases were used. Randomised controlled trials (RCTs) published between 2011-2021 that evaluate the effect of probiotics, prebiotics or synbiotics on patients with CKD by measuring renal parameters and other related outcomes were included. The quality of the included RCTs was assessed using the JADAD scale for reporting randomized controlled trials. Results: Seven eligible RCTs satisfied the stated inclusion criteria and indicated that the supplementation of probiotics, prebiotics or synbiotics did not play a significant impact on eGFR, serum creatinine (Mean difference (MD) -0.08, Confidence interval (CL) -0.39,0.23), the urea level (MD-0.47, CI-9.19,8.25), lipid profile or gastrointestinal symptoms. Furthermore, other parameters could not be analysed due to the lack of a suitable format to be used. Conclusion: According to current evidence, there is no apparent reason to recommend probiotics, prebiotics or synbiotics for patients with CKD. Furthermore, the duration of the studies ranged between 6 weeks and 3 months. Future studies with a longer duration might be needed to clarify any delayed effects. Studies testing their impact on other outcomes are also required.