Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Renal Department, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia; Nutrition Programme, Federal University of Sao Paulo, Sao Paulo, Brazil; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
J Ren Nutr. 2019 May;29(3):209-220. doi: 10.1053/j.jrn.2018.08.008. Epub 2018 Oct 23.
Gut dysbiosis has been implicated in the pathogenesis of chronic kidney disease (CKD). Restoring gut microbiota with prebiotic, probiotic, and synbiotic supplementation has emerged as a potential therapeutic intervention but has not been systematically evaluated in the CKD population.
This is a systematic review. A structured search of MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials, and the International Clinical Trials Register Search Portal was conducted for articles published since inception until July 2017. Included studies were randomized controlled trials investigating the effects of prebiotic, probiotic, and/or synbiotic supplementation (>1 week) on uremic toxins, microbiota profile, and clinical and patient-centered outcomes in adults and children with CKD.
Sixteen studies investigating 645 adults met the inclusion criteria; 5 investigated prebiotics, 6 probiotics, and 5 synbiotics. The quality of the studies (Grades of Recommendation, Assessment, Development and Evaluation) ranged from moderate to very low. Prebiotic, probiotic, and synbiotic supplementation may have led to little or no difference in serum urea (9 studies, 345 participants: mean difference [MD] -0.30 mmol/L, 95% confidence interval [CI] -2.20 to 1.61, P = .76, I = 53%), indoxyl sulfate (4 studies, 144 participants: MD -0.02 mg/dL, 95% CI -0.09 to 0.05, P = .61, I = 0%), and p-cresyl sulfate (4 studies, 144 participants: MD -0.13 mg/dL, 95% CI -0.41 to 0.15, P = .35, I = 0%). Prebiotic supplementation may have slightly reduced serum urea concentration (4 studies, 105 participants: MD -2.23 mmol/L, 95% CI -3.83 to -0.64, P = .006, I = 11). Of the 2 studies investigating microbiota changes, synbiotic interventions significantly increased Bifidobacterium. Supplement effects on clinical outcomes were uncertain.
There is limited evidence to support the use of prebiotics, probiotics, and/or synbiotics in CKD management.
肠道菌群失调与慢性肾脏病（CKD）的发病机制有关。通过补充益生元、益生菌和合生元来恢复肠道微生物群已成为一种潜在的治疗干预措施，但尚未在 CKD 人群中进行系统评估。
这是一项系统评价。对 MEDLINE、CINAHL、EMBASE、Cochrane 对照试验中心注册库和国际临床试验注册平台进行了结构化检索，检索自成立以来至 2017 年 7 月发表的文章。纳入的研究是随机对照试验，研究了益生元、益生菌和/或合生元补充剂（>1 周）对尿毒症毒素、微生物群谱以及成人和儿童 CKD 的临床和患者为中心结局的影响。
纳入了 16 项针对 645 名成人的研究，其中 5 项研究了益生元，6 项研究了益生菌，5 项研究了合生元。研究的质量（推荐评估发展分级）从中等到非常低不等。益生元、益生菌和合生元补充剂对血清尿素（9 项研究，345 名参与者：平均差值[MD] -0.30mmol/L，95%置信区间[CI] -2.20 至 1.61，P=0.76，I=53%）、吲哚硫酸酯（4 项研究，144 名参与者：MD -0.02mg/dL，95%CI -0.09 至 0.05，P=0.61，I=0%）和对甲酚硫酸盐（4 项研究，144 名参与者：MD -0.13mg/dL，95%CI -0.41 至 0.15，P=0.35，I=0%）的影响可能较小或无差异。益生元补充剂可能略微降低了血清尿素浓度（4 项研究，105 名参与者：MD -2.23mmol/L，95%CI -3.83 至 -0.64，P=0.006，I=11%）。在研究微生物群变化的 2 项研究中，合生元干预显著增加了双歧杆菌。补充剂对临床结局的影响尚不确定。
目前证据有限，不能支持在 CKD 管理中使用益生元、益生菌和/或合生元。
