Effects of synbiotic treatment on serum level of p-cresol in haemodialysis patients: a preliminary study

Nakabayashi, Iwao; Nakamura, Motonobu; Kawakami, Koji; Ohta, Toshihisa; Kato, Ikuo; Uchida, Kazumi; Yoshida, Masaharu

doi:10.1093/ndt/gfq624

Cited by 183 publications

(141 citation statements)

References 22 publications

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“…However, in patients who had not received antibiotics during the trial, synbiotic therapy significantly lowered serum levels of both IS and PCS. These findings are consistent with two previous studies that showed significant reductions in IS and PCS with synbiotic therapy in patients with CKD or ESRD (21,22). Synbiotic therapy resulted in a significant increase in the relative abundance of fecal Bifidobacterium and a reduction of Ruminococcaceae bacteria.…”

supporting

confidence: 92%

Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Vaziri¹

2016

Clinical Journal of the American Society of Nephrology

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supporting

confidence: 92%

Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Vaziri¹

2016

Clinical Journal of the American Society of Nephrology

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“…To date, there have been two other synbiotic intervention studies: one controlled trial in predialysis patients (18) and one uncontrolled trial in patients on hemodialysis (19), both of which measured p-cresol (PC; a surrogate marker of PCS [20]). Although no details concerning antibiotic use were provided, both studies reported greater reductions in PC after 30 days (21 mmol/L) and 14 days (26.8 mmol/L), respectively, compared with the SYNERGY Study's primary analysis (14 mmol/L).…”

Section: Discussionmentioning

confidence: 99%

Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY)

Rossi

Johnson

Morrison

et al. 2016

Clinical Journal of the American Society of Nephrology

291

262

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Background and objectives The generation of key uremic nephrovascular toxins, indoxyl sulfate (IS), and p-cresyl sulfate (PCS), is attributed to the dysbiotic gut microbiota in CKD. The aim of our study was to evaluate whether synbiotic (pre-and probiotic) therapy alters the gut microbiota and reduces serum concentrations of microbiome-generated uremic toxins, IS and PCS, in patients with CKD.Design, setting, participants, & measurements Predialysis adult participants with CKD (eGFR=10-30 ml/min per 1.73 m 2 ) were recruited between January 5, 2013 and November 12, 2013 to a randomized, double-blind, placebo-controlled, crossover trial of synbiotic therapy over 6 weeks (4-week washout). The primary outcome was serum IS. Secondary outcomes included serum PCS, stool microbiota profile, eGFR, proteinuria-albuminuria, urinary kidney injury molecule-1, serum inflammatory biomarkers (IL-1b, IL-6, IL-10, and TNF-a), serum oxidative stress biomarkers (F 2 -isoprostanes and glutathione peroxidase), serum LPS, patient-reported health, Gastrointestinal Symptom Score, and dietary intake. A prespecified subgroup analysis explored the effect of antibiotic use on treatment effect.Results Of 37 individuals randomized (age =69610 years old; 57% men; eGFR=2468 ml/min per 1.73 m 2 ), 31 completed the study. Synbiotic therapy did not significantly reduce serum IS (22 mmol/L; 95% confidence interval [95% CI], 25 to 1 mmol/L) but did significantly reduce serum PCS (214 mmol/L; 95% CI, 227 to 22 mmol/L). Decreases in both PCS and IS concentrations were more pronounced in patients who did not receive antibiotics during the study (n=21; serum PCS, 225 mmol/L; 95% CI, 238 to 212 mmol/L; serum IS, 25 mmol/L; 95% CI, 28 to 21 mmol/L). Synbiotics also altered the stool microbiome, particularly with enrichment of Bifidobacterium and depletion of Ruminococcaceae. Except for an increase in albuminuria of 38 mg/24 h (P=0.03) in the synbiotic arm, no changes were observed in the other secondary outcomes. ConclusionIn patients with CKD, synbiotics did not significantly reduce serum IS but did decrease serum PCS and favorably modified the stool microbiome. Large-scale clinical trials are justified.

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“…The effect of prebiotics on other intestinal metabolites in CKD is currently unknown, and studies on the efficacy of prebiotics in preventing CKD-associated metabolic disturbances in humans are lacking (Figure 2). Nakabayashi et al used supplemental symbiotics (probiotic combined with prebiotic) for two weeks and observed significant reductions in p-cresyl sulfate levels and the normalization of bowel habits in hemodialysis patients [88]. Furthermore, AST-120, an oral adsorbent capable of binding solutes and preventing their intestinal absorption represents a type of therapy able to reduce the levels of indoxyl sulfate [89].…”

mentioning

confidence: 99%

Role of Altered Intestinal Microbiota in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease

et al. 2014

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The normal intestinal microbiota plays a major role in the maintenance of health and disease prevention. In fact, the alteration of the intestinal microbiota has been shown to contribute to the pathogenesis of several pathological conditions, including obesity and insulin resistance, among others. Recent studies have revealed profound alterations of the gut microbial flora in patients and animals with chronic kidney disease (CKD). Alterations in the composition of the microbiome in CKD may contribute to the systemic inflammation and accumulation of gut-derived uremic toxins, which play a central role in the pathogenesis of accelerated cardiovascular disease and numerous other CKD-associated complications. This review is intended to provide a concise description of the potential role of the CKD-associated changes in the gut microbiome and its potential role the pathogenesis of inflammation and uremic toxicity. In addition, the potential efficacy of pre- and pro-biotics in the restoration of the microbiome is briefly described.

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Effects of synbiotic treatment on serum level of p-cresol in haemodialysis patients: a preliminary study

Cited by 183 publications

References 22 publications

Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Effect of Synbiotic Therapy on Gut–Derived Uremic Toxins and the Intestinal Microbiome in Patients with CKD

Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY)

Role of Altered Intestinal Microbiota in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease

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