Introduction. Dysbiosis microbiota is considered as one of the consequences and impacts of high uremic toxins in patients with Chronic Kidney Disease (CKD), which can lead to an increased risk of progression and mortality. The aim of this systematic review and meta-analysis was to perform quantitative effect of microbiota modulation for estimated Glomerular Filtration Rate (eGFR), uremic toxin (total-p cresyl/total pCS), and inflammatory marker (hs-CRP) outcome among CKD patients. Methods. Article searches were conducted from PubMed, ScienceDirect, and Cochrane Library data sources from 2010-2022. Assessment of article quality follows the rules of PRISMA (Preferred Reporting Items in Systematic Review and Meta-Analysis). Only randomized controlled trial (RCT) articles investigating the effect of symbiotic, prebiotic, of probiotic for CKD were included in the analysis. Effect size quantify from Standardized Mean Difference (SMD), using a continuous random effect model and described in the forest plot model. Results. A total of 17 RCT studies with a total 867 CKD stage 1-5 subjects (440 subjects in the intervention group and 427 subjects in the control group). The intervention duration ranging from 1-12 months. The studies included had varied on methodologies, with significant heterogenicity (I296,96%, p Conclusions. The administration of probiotic/prebiotic/symbiotic supplements to CKD patients resulted in significant improvements in e-GFR and reductions in total pCS. These results suggest the potential of symbiotic, prebiotic, and probiotic supplementation to improve CKD outcome.
Background: Liver cirrhosis (LC) is still being important public health concern, due to the rising of global incidence and mortality. There is risk progression in LC patients to acute-on-chronic liver failure (ACLF) patients with high incidence of complication and high short-term mortality rate. It needs rapid and simpler predictor to immediate and accurate triage of the patient. The aim of this study is to review systematically the role of PWR to predict the mortality in ACLF cirrhosis patient.Method: This systematic review study was identified by searching Pub-Med, Cochrane library, and EMBASE database (2016-2022). Only observational studies were included. ACLF patient was selected as the main subject in each study, and PWR was added as short-term mortality predictor. The Cochran seven step model was used to perform the review.Results: Six cohort retrospective studies met inclusion criteria, including total 1,348 patient ACLF. Half of studies included had high level of evidence. The non-survivor ACLF patient had significantly lower PWR values than survivor. The range of HR of PWR to predict mortality in ACLF was 0.665-0.995, with p value 0.0001. Whereas the cutoff range of PWR value to predict non survivor in ACLF patient was 7.83-14.2.Conclusion: PWR had a predictive efficacy, similar to CLIF-SOFA and MELD score in terms of predicting short-term mortality in ACLF patients. PWR showed significantly independent risk factor of short term mortality in ACLF cirrhotic patient.
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