The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

March, DS, Jones, Arwel, Bishop, NC and Burton, JO (2019) The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Journal of Renal Nutrition . ISSN 1051-2276

Full content URL: https://doi.org/10.1053/j.jrn.2019.07.006 show

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The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled T
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Abstract

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.

Keywords:prebiotic, probiotic, synbiotic, microbiota, end-stage renal disease, systematic review, meta-analysis
Subjects:B Subjects allied to Medicine > B400 Nutrition
A Medicine and Dentistry > A300 Clinical Medicine
Divisions:College of Social Science > Lincoln Institute of Health
ID Code:37875
Deposited On:22 Oct 2019 10:00

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