Pediatric Nephrology Research Center, Research Institute for Children's Health, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Nutritional Science, School of Nutritional Science and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Clin Ther. 2021 Mar;43(3):e71-e96. doi: 10.1016/j.clinthera.2020.12.021. Epub 2021 Jan 30.
Chronic kidney disease (CKD) is a major health problem worldwide. Evidence supporting the use of probiotic, prebiotic, and synbiotic supplementation in the management of CKD is mixed, although some studies suggest they may be useful. A systematic review and meta-analysis was performed to evaluate the effectiveness of probiotic, prebiotic, and synbiotic supplementation for improving cardiometabolic and oxidative stress parameters in patients with CKD.
A comprehensive key word search was performed in EMBASE, Medline, Scopus, Cochrane Central, and Web of Science until April 2020. Randomized controlled trials investigating the effectiveness of probiotic, synbiotic, and prebiotic supplementation for the management of adults with CKD were included. Primary outcomes were measures of cardiometabolic parameters such as cholesterol and fasting blood glucose. Secondary outcomes were measures of oxidative stress (eg, malondialdehyde levels) and body mass index. Random effects meta-analyses were used to estimate mean treatment effects. Results are reported as standardized mean differences (SMDs) and 95% CIs.
Fourteen articles were included. In patients with CKD, probiotic, prebiotic, and synbiotic supplementation significantly reduced total cholesterol (SMD, -0.25; 95% CI, -0.46 to -0.04; I = 00.0%), fasting blood glucose (SMD, -0.41; 95% CI, -0.65 to -0.17; I = 00.0%), homeostatic model assessment of insulin resistance (SMD, -0.63; 95% CI, -0.95 to -0.30; I = 43.3%), insulin levels (SMD, -0.49; 95% CI, -0.90 to -0.08; I = 65.2%), high-sensitivity C-reactive protein levels (SMD, -0.52; 95% CI, -0.81 to -0.22; I = 52.7%), and malondialdehyde levels (SMD, -0.79; 95% CI, -1.22 to -0.37; I = 69.8%) compared with control interventions. Supplementation significantly increased the quantitative insulin sensitivity check index (SMD, 0.78; 95% CI, 0.51 to 1.05; I = 00.0%), total antioxidant capacity (SMD, 0.42; 95% CI, 0.18 to 0.66; I = 00.0%), and glutathione levels (SMD, 0.52; 95% CI, 0.19 to 0.86; I = 37.0%).
Probiotic, prebiotic, and synbiotic supplementation seems to be a promising intervention for improving cardiometabolic and oxidative stress parameters in patients with CKD.
慢性肾脏病（CKD）是全球范围内的一个主要健康问题。虽然一些研究表明益生菌、益生元和合生剂补充剂可能有用，但支持将其用于 CKD 管理的证据仍存在差异。本文进行了一项系统评价和荟萃分析，以评估益生菌、益生元和合生剂补充剂在改善 CKD 患者的心血管代谢和氧化应激参数方面的有效性。
我们在 EMBASE、Medline、Scopus、Cochrane 中心和 Web of Science 中进行了全面的关键词搜索，检索时间截至 2020 年 4 月。纳入了评估益生菌、合生剂和益生元补充剂用于管理成人 CKD 的有效性的随机对照试验。主要结局指标为胆固醇和空腹血糖等心血管代谢参数的测量值。次要结局指标为氧化应激（如丙二醛水平）和体重指数。使用随机效应荟萃分析来估计平均治疗效果。结果以标准化均数差（SMD）和 95%置信区间（CI）表示。
共纳入 14 篇文章。在 CKD 患者中，益生菌、益生元和合生剂补充剂可显著降低总胆固醇（SMD，-0.25；95%CI，-0.46 至-0.04；I²=0.0%）、空腹血糖（SMD，-0.41；95%CI，-0.65 至-0.17；I²=0.0%）、稳态模型评估的胰岛素抵抗（SMD，-0.63；95%CI，-0.95 至-0.30；I²=43.3%）、胰岛素水平（SMD，-0.49；95%CI，-0.90 至-0.08；I²=65.2%）、高敏 C 反应蛋白水平（SMD，-0.52；95%CI，-0.81 至-0.22；I²=52.7%）和丙二醛水平（SMD，-0.79；95%CI，-1.22 至-0.37；I²=69.8%），与对照组相比。与对照组相比，补充剂可显著提高定量胰岛素敏感性检查指数（SMD，0.78；95%CI，0.51 至 1.05；I²=0.0%）、总抗氧化能力（SMD，0.42；95%CI，0.18 至 0.66；I²=0.0%）和谷胱甘肽水平（SMD，0.52；95%CI，0.19 至 0.86；I²=37.0%）。
益生菌、益生元和合生剂补充剂似乎是改善 CKD 患者心血管代谢和氧化应激参数的有希望的干预措施。
