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Abstract: SA-PO471

Effects of Probiotics and Fibers on Markers of Nephropathy and Endothelial Dysfunction in Persons with Type 1 Diabetes and Albuminuria

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Stougaard, Elisabeth B., Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Tougaard, Ninna Hahn, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Rotbain Curovic, Viktor, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Sivalingam, Suvanjaa, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Hansen, Christian Stevns, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Hansen, Tine, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Frimodt-Moller, Marie, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Steinert, Robert E., dsm firmenich, Kaiseraugst, Switzerland
  • Persson, Frederik, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
  • Rossing, Peter, Steno Diabetes Center Copenhagen, Herlev, Capital Region, Denmark
Background

Recent data have pointed towards a link between gut microbiota and chronic kidney disease. Defects in the intestinal barrier due to microbial imbalance allow bacterial toxins to pass and cause systemic inflammation damaging the endothelium. Fibers serve as substrate for the beneficial bacterial strains, together with probiotics they have a positive effect on the gut environment, reestablish the microbial symbiosis and thereby strengthen the gut barrier in experimental models. We hypothesized that a supplement of fructo-oligosaccharides and probiotics would strengthen the gut barrier and protect the endothelium and kidneys.

Methods

A randomized, double blind, placebo controlled, crossover study including 41 persons with type 1 diabetes and albuminuria (urinary albumin-to-creatinine ratio (UACR) >30 mg/g) on renin-angiotensin-system blockade. Participants received synbiotic mix and matched placebo for 12 weeks in a random order with 6 weeks of washout. The primary end point was change from baseline to end of period in UACR (3 morning urine samples per visit). Secondary endpoints were: Change from baseline to end of period in endothelial glycocalyx thickness (perfused boundary region) and in inflammatory markers; end-of-period glomerular filtration rate (GFR) and ambulatory systolic blood pressure measured after each treatment period with synbiotic mix versus placebo.

Results

A total of 41 participants were randomized and 35 completed the study. Mean age was 58 (SD 10) years, 73% (n=30) were male, median UACR was 134 (IQR 63-293) mg/g, estimated GFR was 75 (30) ml/min/1.73m2. There was no significant difference in UACR with a mean relative change (CI 95 %) from baseline to end-of-treatment of -3.0 (-18.4; 15.5) % in the synbiotic group and -12.0 (-29.6; 9.6) % in the placebo group with no significant difference between treatment periods (9.37 (-25.2; 44.0) percentage points; p = 0.60). No significant difference in the secondary end points was demonstrated.

Conclusion

Twelve weeks treatment with a supplement of synbiotic mix had no effect on UACR, perfused boundary region, inflammatory markers, GFR or ambulatory systolic blood pressure in subjects with type 1 diabetes and albuminuria.

Funding

  • Commercial Support – Novo Nordisk Foundation (Grant number: NNF OC0013659) and DSM Nutritional Products Ltd. Kaiseraugst