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Effect of probiotics on the intestinal microbiota of hemodialysis patients: a randomized trial

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Abstract

Background

Intestinal dysbiosis contributes to the progression of renal failure and cardiovascular diseases in patients with chronic kidney disease. Probiotics is a promising intervention to improving intestinal dysbiosis. A double-blind clinical trial to investigate the ability of probiotics to modulate gut microbiota compositions in patients receiving hemodialysis (HD) was undertaken.

Methods

Fifty HD patients were enrolled and randomized, receiving either probiotics or placebo for 6 months. The responses to the interventions on gut microbiome, serum and fecal metabolome, serum albumin and endotoxin, endothelial activation markers and inflammatory markers were assessed.

Results

Totally, 22 in the probiotics group (11 males; 14 non-diabetic) and 23 in the placebo group (13 males; 17 non-diabetic) completed the study. Compared to that in the placebo group, probiotics did not significantly alter species diversity of the fecal microbiome. Probiotics did, however, restore the community composition, with particular significance in non-diabetic HD patients (P = 0.007 by Adonis analysis). Specifically, according to the results of linear discriminate analysis effect size, probiotics raised the proportions of family Bacteroidaceae and Enterococcaceae, and reduced Ruminococcaceae, Halomonadaceae, Peptostreptococcaceae, Clostridiales Family XIII. Incertae Sedis and Erysipelotrichaceae in non-diabetic HD patients. Additionally, probiotics reduced the abundances of several uremic retention solutes in serum or feces, including indole-3-acetic acid-O-glucuronide, 3-guanidinopropionic acid, and 1-methylinosine (P < 0.05). In the probiotic arm, no significant changes were observed in other secondary outcomes.

Conclusions

Taken together, outcomes from this study suggest that probiotics do have benefits on improving intestinal imbalances and lowering exposure to several uremic toxins in HD patients.

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Acknowledgements

We gratefully acknowledge Qiong Gao and Xiaomin Liu for assistance as the study nurses, and Sine pharmaceutical company for providing free placebo capsules. In addition, we also would like to thank Editage for English language editing.

Funding

This study was supported by Shannxi Provincial Science and Technology Foundation (Grant no. 2017ZDXM-SF-057) and the National Natural Science Foundation of China (Grant no. 81570670).

Author information

Author notes

  1. Sixiu Liu, Hua Liu, and Lei Chen contributed equally.

Authors and Affiliations

  1. Dialysis Department of Nephrology Hospital, The First Affiliated Hospital of Xi’an Jiaotong University, West Yanta Road 277, Xi’an, 710061, Shaanxi, China

    Sixiu Liu, Hua Liu, Lei Chen, Shan-Shan Liang, Kehui Shi, Wang Meng, Jinhong Xue, Quan He & Hongli Jiang

  2. Department of Nephrology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China

    Sixiu Liu

Authors
  1. Sixiu Liu
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  2. Hua Liu
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Contributions

HJ contributed to study concept and design, acquisition of data, data analyses, interpretation of data, drafting of the manuscript, critical review of the manuscript, other support (administrative, technical, material), and study supervision. SL, HL, and LC performed data analyses and contributed to study concept and design, interpretation of data, drafting of the manuscript, critical review of the manuscript, statistical analysis, and led study supervision. SSL, KS, and JX conducted the study per protocol, contributed to patient acquisition, acquisition of data and drafting of the manuscript. MW and QH contributed to acquisition of data, interpretation of data, and critical review of the manuscript.

Corresponding author

Correspondence to Hongli Jiang.

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Conflict of interest

None declared.

Ethics approval and consent to participate

The Ethical Committees of First Affiliated Hospital of Xi’an Jiaotong University approved the study (XJTU1AF2016LSL-015). All participant provided written informed consent.

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Liu, S., Liu, H., Chen, L. et al. Effect of probiotics on the intestinal microbiota of hemodialysis patients: a randomized trial. Eur J Nutr 59, 3755–3766 (2020). https://doi.org/10.1007/s00394-020-02207-2

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  • DOI: https://doi.org/10.1007/s00394-020-02207-2

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