Abstract: SA-PO1015
The Efficacy of Probiotic, Prebiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated with Mortality in Dialysis Patients: Systematic Review and Meta-Analysis
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- March, Daniel Scott, University of Leicester, Leicester, United Kingdom
- Jones, Arwel W., University of Lincoln, Lincoln, United Kingdom
- Bishop, Nicolette C., Loughborough Univeristy, Loughborough, United Kingdom
- Burton, James, University of Leicester, Leicester, United Kingdom
Background
There is accumulating evidence that modification of the microbiota through prebiotic, probiotic or synbiotic supplementation in individuals with end-stage renal disease receiving dialysis may be efficacious in reducing circulating levels of toxic metabolites. This systematic review and meta-analyses provides an up to date synthesis on the effects of supplementation on circulating levels of toxic metabolites, markers of uremia and inflammation, blood lipids and other clinical outcomes.
Methods
Seventeen databases were searched, supplemented with internet and hand searching. Randomised controlled trials of adult end stage renal-disease individuals receiving either haemodialysis or peritoneal dialysis were eligible. Trials were restricted to those which had administered a prebiotic, probiotic or synbiotic as an oral supplement. Primary outcomes were measures of circulating endotoxin, indoxyl-sulphate and p-cresyl sulphate.
Results
Twenty-one trials were eligible (1152 randomised participants) of which 19 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesised data indicated that supplementation significantly reduced circulating levels of endotoxin (standardised mean difference -0.61, 95% confidence interval -1.03 to -0.20, P=0.004, I2=0%), indoxyl-sulphate (-0.34, -0.64 to -0.04, P=0.02, I2=0%) and p-cresyl sulphate (-0.34, -0.61 to -0.07, P=0.01, I2=0%). For secondary outcomes supplementation significantly reduced gastrointestinal symptoms (-0.54, -1.02 to -0.07, P=0.02, I2=0%). There were no significant effects on any secondary outcome measure.
Conclusion
Supplementation reduces toxic metabolites associated with cardiovascular disease and mortality in individuals receiving dialysis. However, the majority of trials included were low in quality.