Synbiotics safe, effective at cutting uraemic toxins in CKD

Patients with chronic kidney disease (CKD) can safely use synbiotics to reduce their levels of uraemic toxins and minimize microinflammation, reports a new study.

Researchers conducted a randomized, double-blinded, and placebo-controlled study enrolling 34 nondialysed CKD patients. Half were given a synbiotic intervention consisting of Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium lactis, at a dose of 32 billion cfu per day, along with 3.2 g of inulin. The other half was designated as controls.

The study primary outcome was the intervention impact on dynamic serum concentrations of gut-derived uraemic toxins such as p-cresyl sulphate, indoxyl sulphate, and N-oxide. Stool microbiome, estimated glomerular filtration rate (eGFR), serum interleukin levels, and high-sensitivity C-reactive protein (hs-CRP) concentration, among others, were set as secondary endpoints.

Patients in the synbiotic intervention arm saw significant alterations to their gut microbiome characterized by improved enrichment of the Bifidobacteria, Lactobacillus, and Subdoligranulum genera.

Synbiotics likewise led to a significant reduction in serum indoxyl sulphate concentrations, which dropped by 21.5 percent in those taking the active intervention but increased by 5.3 percent in placebo controls (p<0.001). EGFR also showed significantly better improvement after synbiotic vs placebo intervention (12 percent vs 8 percent; p=0.029).

Meanwhile, hs-CRP levels were more strongly decreased in the synbiotic arm (39.5 percent vs 8.5 percent p<0.001).

In terms of safety, two synbiotic recipients had increased flatulence, though no other side effects were reported.