Uremic toxin management with pre- and probiotics: a meta-analysis

Abstract

This review evaluated the effectiveness of pre-, pro- and synbiotics on reducing a nephro-vascular uremic toxin, indoxyl sulphate (IS), involved in cardiovascular disease in chronic kidney disease. A review of the literature using Cochrane, PUBMED, EMBASE and CINAHL was conducted from 1951 to 2011 (inclusive). Studies were included if they reported change in IS (or their precursors) as outcome measures in pre-, pro- or synbiotic interventions with a duration of more than one day, were in English language, in human adults with chronic kidney disease (Stage I to V (dialysis)). From the 87 papers identified, five met the inclusion criteria involving 87 patients, all of whom were receiving hemodialysis. One study investigated prebiotics, three probiotics and one synbiotics. The quality of the studies was limited (GRADE either low or very low). Summary statistics were translated into means and standard errors, assuming normal distribution. fx1 There is limited but supportive evidence for the effectiveness of pre- and probiotics on reducing IS in the chronic kidney disease population. Well-designed fully-powered studies are needed in order to evaluate the potential use of this treatment in the clinical setting.