3. 3
Probiotics, Prebiotics, and Synbiotics in
patients with Chronic Kidney Disease
Monireh Dahri
Ph.D of Nutrition
Jan 2022
4. Gastrointestinal Microbiota
approximately 1 trillion of microorganism with thousands of species
encoding more than 3 million of genes (150-fold more than human
genome)
4
Jazani NH, 2019
6. Gut-Kidney Axis
association between CDK, the GI environment, and changes in the
gut epithelial barrier permeability, maintenance of normal
homeostasis
dysregulation of this axis in CKD progression
CKD is associated with gut dysbiosis
6
7. Gut-Kidney Axis
CKD significantly modifies
the composition and
functions of the gut
microbiota and contributes
to dysbiosis in humans
gut microbiota is able to
manipulate the processes leading
to CKD onset and progression
through inflammatory, endocrine,
and neurologic pathways
7
Firouzi and Haghighatdoost 2018
Pisano et al. 2018
McFarlane et al. 2019
8. Dysbiosis
imbalance in gut microbiota composition and its metabolic capacity that could promote
chronic diseases including kidney disease
pathogenic bacteria predominate and synthetize different harmful substances and toxins
causing chronic immune activation
8
Jazani NH, 2019
9. 9
new therapies aimed at restoring the symbiotic
intestinal environment using dietary prebiotic,
probiotic, or synbiotic supplements, as well as
improving metabolic changes, are promising
targeted strategies to either delay or reverse
disease progression
10. Probiotics
living microorganisms
in adequate doses improve the intestinal microbiota profile by increasing
beneficial bacteria
maintaining gut epithelium barrier function
competition with pathogenic bacteria for nutrients
regulation of host immune response
some strains of probiotics can improve host metabolism
mitigate uremic intoxication
reduce pro-inflammatory markers
delay the progression of renal dysfunction
10
K. A. Lee et al. 2021
Soleimani et al. 2017
11. Best sources of probiotic foods
Yogurt
Traditional buttermilk
Pickles
Kimchi
Sauerkraut
Cheese
Kefir
11
12. Prebiotics
nonliving indigestible fibers
stimulate the growth and/or activity of beneficial microorganisms in the gut
Prebiotics that favor the proliferation of health promoting bacteria such as
Bifidobacteria and Lactobacilli modulate relevant processes in CKD
* mitigating the production of colon-derived uremic solutes
* increasing the production of short-chain fatty acids (SCFAs), which can regulate the
incretin axis and reduce inflammation
12
K. A. Lee et al. 2021
Soleimani et al. 2017
14. Synbiotics
probiotic strains feed off of prebiotic substrates
the synbiotics are combined in a supplement to act synergistically to
promote host gastrointestinal health
14
K. A. Lee et al. 2021
Soleimani et al. 2017
17. Findings from the meta-analysis
Effect on biomarker of inflammation
Effect on biomarkers of oxidative stress
Effect on biomarkers of lipid profiles
17
18. 18
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on CRP
19. 19
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on TAC
20. 20
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on GSH
21. 21
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on MDA
22. 22
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on TC
23. 23
Forest plot of the effect of probiotic, prebiotic, and synbiotic supplementation on HDL
24. supplementation with probiotics, prebiotics, and synbiotics
24
decrease pro-inflammatory biomarker (CRP)
ameliorate the lipid profile (TC, HDL, and LDL)
improve the oxidative unbalance among pro-oxidant
factors and anti-oxidant enzymes (MDA, GSH, and TAC)
did not affect the other lipid profile (TG) in CKD patients
25. 25
The beneficial effects of the symbiotic combination of
pro- and prebiotics could be the result of the synergistic
actions involved in their anti-inflammatory, anti-oxidant
and lowering-lipid properties during CKD progression
26. supplementation with probiotics, prebiotics, and synbiotics
26
A reduction of TC and LDL-c is associated with deceased
cardiovascular events in individuals with CKD, and this effect
on the lipid metabolism may help in the administration of
CKD-associated cardiovascular diseases
28. interventions with prebiotics, probiotics, and synbiotics
long-term (12-week) was statistically more effective in decreasing
CRP and MDA levels than short-term (<12-week)
a higher reduction of CRP and MDA levels were observed for
patients aged <55years old compared to those 55 or older
subgroup analysis on proinflammatory indicator (CRP) and
increased oxidative stress status (MDA) in CKD patients with
baseline BMI < 26kg/ m2 than BMI 26kg/m2
the combination has a larger effect on the CRP level compared with
the isolated use of probiotics or prebiotics in CKD settings
28
Heshmati et al. 2018
Hui Juan Zheng et al. 2020
Shinde et al. 2019
Kazemi et al. 2020
29. Mechanisms of CKD-induced dysbiosis
Diet restrictions
Slow colonic transit
Changes in the GI tract biochemical environment
Medications
29
Natalia Lucía Rukavina Mikusic, 2020
36. References
Zheng HJ, Guo J, Wang Q, Wang L, Wang Y, Zhang F, Huang WJ, Zhang W,
Liu WJ, Wang Y. Probiotics, prebiotics, and synbiotics for the improvement
of metabolic profiles in patients with chronic kidney disease: A systematic
review and meta-analysis of randomized controlled trials. Critical reviews in
food science and nutrition. 2021 Feb 21;61(4):577-98.
Feng Z, Wang T, Dong S, Jiang H, Zhang J, Raza HK, Lei G. Association
between gut dysbiosis and chronic kidney disease: a narrative review of
the literature. Journal of International Medical Research. 2021
Oct;49(10):03000605211053276.
Aron-Wisnewsky J, Clément K. The gut microbiome, diet, and links to
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Mar;12(3):169-81.
Rodrigues FG, Ormanji MS, Heilberg IP, Bakker SJ, de Borst MH. Interplay
between gut microbiota, bone health and vascular calcification in chronic
kidney disease. European journal of clinical investigation. 2021 May
4:e13588.
36
37. References
Mikusic NL, Kouyoumdzian NM, Choi MR. Gut microbiota and chronic
kidney disease: evidences and mechanisms that mediate a new
communication in the gastrointestinal-renal axis. Pflügers Archiv-European
Journal of Physiology. 2020 Mar;472(3):303-20.
Lee KA, Luong MK, Shaw H, Nathan P, Bataille V, Spector TD. The gut
microbiome: What the oncologist ought to know. British journal of cancer.
2021 Oct;125(9):1197-209.
Zafar H, Saier Jr MH. Gut Bacteroides species in health and disease. Gut
Microbes. 2021 Jan 1;13(1):1-20.
Fagundes RA, Soder TF, Grokoski KC, Benetti F, Mendes RH. Probiotics in the
treatment of chronic kidney disease: a systematic review. Brazilian Journal
of Nephrology. 2018 Jun 21;40:278-86.
Jia L, Jia Q, Yang J, Jia R, Zhang H. Efficacy of probiotics supplementation
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