TY - JOUR
T1 - The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis
T2 - A Systematic Review and Meta-analysis of Randomized Controlled Trials
AU - March, Daniel S.
AU - Jones, Arwel W.
AU - Bishop, Nicolette C.
AU - Burton, James O.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Objective: This systematic review and meta-analyses provide an up-to-date synthesis on the effects of supplementation on circulating levels of toxic metabolites, markers of uremia and inflammation, blood lipids, and other clinical outcomes. Methods: Seventeen databases were searched, supplemented with internet and hand searching. Randomized controlled trials of adult end-stage renal-disease individuals receiving either hemodialysis or peritoneal dialysis were eligible. Trials were restricted to those which had administered a prebiotic, probiotic, or synbiotic as an oral supplement. Primary outcomes were measures of circulating endotoxin, indoxyl-sulphate, and p-cresyl sulfate. Results: Twenty-one trials were eligible (1152 randomized participants), of which 16 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesized data indicated that supplementation significantly reduced circulating levels of endotoxin (standardized mean difference, −0.61; 95% confidence interval, −1.03 to −0.20; P =.004; I2 = 0%), indoxyl-sulphate (−0.34; −0.64 to −0.04; P =.02; I2 = 0%), and p-cresyl sulfate (−0.34; −0.61 to −0.07; P =.01; I2 = 0%). For secondary outcomes, supplementation significantly reduced gastrointestinal symptoms (−0.54; −1.02 to −0.07; P =.02; I2 = 0%). Conclusions: Supplementation reduces toxic metabolites associated with cardiovascular disease and mortality in individuals receiving dialysis. However, the majority of trials included were low in quality.
AB - Objective: This systematic review and meta-analyses provide an up-to-date synthesis on the effects of supplementation on circulating levels of toxic metabolites, markers of uremia and inflammation, blood lipids, and other clinical outcomes. Methods: Seventeen databases were searched, supplemented with internet and hand searching. Randomized controlled trials of adult end-stage renal-disease individuals receiving either hemodialysis or peritoneal dialysis were eligible. Trials were restricted to those which had administered a prebiotic, probiotic, or synbiotic as an oral supplement. Primary outcomes were measures of circulating endotoxin, indoxyl-sulphate, and p-cresyl sulfate. Results: Twenty-one trials were eligible (1152 randomized participants), of which 16 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesized data indicated that supplementation significantly reduced circulating levels of endotoxin (standardized mean difference, −0.61; 95% confidence interval, −1.03 to −0.20; P =.004; I2 = 0%), indoxyl-sulphate (−0.34; −0.64 to −0.04; P =.02; I2 = 0%), and p-cresyl sulfate (−0.34; −0.61 to −0.07; P =.01; I2 = 0%). For secondary outcomes, supplementation significantly reduced gastrointestinal symptoms (−0.54; −1.02 to −0.07; P =.02; I2 = 0%). Conclusions: Supplementation reduces toxic metabolites associated with cardiovascular disease and mortality in individuals receiving dialysis. However, the majority of trials included were low in quality.
UR - http://www.scopus.com/inward/record.url?scp=85073063226&partnerID=8YFLogxK
U2 - 10.1053/j.jrn.2019.07.006
DO - 10.1053/j.jrn.2019.07.006
M3 - Review Article
C2 - 31607550
AN - SCOPUS:85073063226
VL - 30
SP - 347
EP - 359
JO - Journal of Renal Nutrition
JF - Journal of Renal Nutrition
SN - 1051-2276
IS - 4
ER -