Yu Zixian, Zhao Jin, Qin Yunlong, Wang Yuwei, Zhang Yumeng, Sun Shiren
Department of Nephrology, Xijing Hospital, Air Force Military Medical University, Xi'an, China.
Front Nutr. 2022 Apr 4;9:850425. doi: 10.3389/fnut.2022.850425. eCollection 2022.
Probiotics, prebiotics, and synbiotics are three different supplements to treat end stage renal disease (ESRD) patients by targeting gut bacteria. The comprehensive comparison of the effectiveness of different supplements are lacking.
The purpose of this network meta-analysis (NMA) is to assess and rank the efficacy of probiotics, prebiotics, and synbiotics on inflammatory factors, uremic toxins, and gastrointestinal symptoms (GI symptoms) in ESRD patients undergoing dialysis.
Randomized clinical trials were searched from the PubMed, Embase, and Cochrane Register of Controlled Trials databases, from their inception until 4 September 2021. Random-effect model were used to obtain all estimated outcomes in network meta-analysis (NMA). Effect estimates were presented as mean differences (Mean ± SD) with 95% confidence interval (CI). The comprehensive effects of all treatments were ranked by the surface under the cumulative ranking (SUCRA) probabilities.
Twenty-five studies involved 1,106 participants were included. Prebiotics were superior in decreasing Interleukin-6 (IL-6; SMD -0.74, 95% CI [-1.32, -0.16]) and tumor-necrosis factor-α (TNF-α; SMD -0.59, 95% CI [-1.09, -0.08]), synbiotics were more effective in declining C-reactive protein (CRP; SMD -0.69, 95% CI [-1.14, -0.24]) and endotoxin (SMD -0.83, 95% CI [-1.38, -0.27]). Regarding uremic toxins, prebiotics ranked highest in reducing indoxyl sulfate (IS; SMD -0.43, 95% CI [-0.81, -0.05]), blood urea nitrogen (BUN; SMD -0.42, 95% CI [-0.78, -0.06]), and malondialdehyde (MDA; SMD -1.88, 95% CI [-3.02, -0.75]). Probiotics were rated as best in alleviating GI symptoms (SMD: -0.52, 95% CI [-0.93, -0.1]).
Our research indicated prebiotics were more effective in declining IL-6, TNF-α, IS, MDA, and BUN, synbiotics lowering CRP and endotoxin significantly, and probiotics were beneficial for alleviating GI symptoms, which may contribute to better clinical decisions. This study was registered in PROSPERO (Number: CRD42021277056).
[http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42021277056].
益生菌、益生元及合生元是三种通过针对肠道细菌来治疗终末期肾病（ESRD）患者的不同补充剂。目前缺乏对不同补充剂有效性的全面比较。
本网状荟萃分析（NMA）的目的是评估并排序益生菌、益生元及合生元对接受透析的ESRD患者炎症因子、尿毒症毒素及胃肠道症状（GI症状）的疗效。
从PubMed、Embase及Cochrane对照试验注册库数据库建库至2021年9月4日检索随机临床试验。在网状荟萃分析（NMA）中使用随机效应模型来获得所有估计结果。效应估计值以均数差（Mean ± SD）及95%置信区间（CI）表示。所有治疗的综合效应通过累积排序曲线下面积（SUCRA）概率进行排序。
纳入了25项研究，共1106名参与者。益生元在降低白细胞介素-6（IL-6；标准化均数差 -0.74，95% CI [-1.32, -0.16]）和肿瘤坏死因子-α（TNF-α；标准化均数差 -0.59，95% CI [-1.09, -0.08]）方面更具优势，合生元在降低C反应蛋白（CRP；标准化均数差 -0.69，95% CI [-1.14, -0.24]）和内毒素（标准化均数差 -0.83，95% CI [-1.38, -0.27]）方面更有效。关于尿毒症毒素，益生元在降低硫酸吲哚酚（IS；标准化均数差 -0.43，95% CI [-0.81, -0.05]）、血尿素氮（BUN；标准化均数差 -0.42，95% CI [-0.78, -0.06]）和丙二醛（MDA；标准化均数差 -1.88，95% CI [-3.02, -0.75]）方面排名最高。益生菌在缓解GI症状方面被评为最佳（标准化均数差：-0.52，95% CI [-0.93, -0.1]）。
我们的研究表明，益生元在降低IL-6、TNF-α、IS、MDA和BUN方面更有效，合生元能显著降低CRP和内毒素，益生菌有利于缓解GI症状，这可能有助于做出更好的临床决策。本研究已在PROSPERO注册（注册号：CRD42021277056）。
